经口内镜下肌切开术治疗贲门失弛缓症的中长期疗效

Intermediate and Long-term Efficacies of Peroral Endoscopic Myotomy for Achalasia

【目的】探讨经口内镜下肌切开术（POEM ）治疗贲门失弛缓症（AC ）的中长期疗效。【方法】应用POEM治疗133例AC患者，术后定期随访，收集患者一般情况、症状评分、并发症、复发、内镜及钡餐检查等资料。【结果】133例患者均成功完成手术，平均操作时间为58．8 min ，隧道长度平均为13．5 cm ，肌切开长度平均为10．4 cm。术后患者症状明显缓解，Eckardt评分较术前明显降低（6．4 vs 0．5，P ＜0．001）；食管直径较术前显著缩小（59．0mmvs32．4mm，P ＜0．001）；并发症发生率为6．8％（9／133），其中气肿发生率为4．5％（6／133）；平均随访19．3个月，99．2％（132／133）有效，随访期内无一例复发。【结论】POEM 治疗AC可获得满意的中长期疗效，其远期疗效及并发症仍有待于进一步随访评估。

[Objective] To evaluate the intermediate and long‐term efficacies of peroral endoscopic myoto‐my （POEM） for patients with achalasia .[Methods] A total of 133 patients with achalasia underwent POEM . And the clinical data of Eckardt＇s score ,complications ,recurrence ,endoscopic examination and esophageal barium radiography were collected before and during regular follow‐ups .[Results] POEM was performed all successfully .The mean operative duration was 58 .8 minutes and the average lengths of tunnel and myotomy were 13 .5 and 10 .4 cm .Symptoms remitted in all of them .Eckardt＇s score decreased significantly （pre‐ vs post‐treatment ,6 .4 vs 0 .5 ,P〈0 .001） .And the diameter of esophageal lumen decreased （pre‐vs post‐treat‐ment ,59 .0 vs 32 .4 mm ,P〈0 .001） .The incidence of complications was 6 .8% （9/133） and gas‐related com‐plications had an incidence of 4 .5% （6/133） .Treatment success was achieved in 99 .2% （132/133） with a me‐dian follow‐up period of 19 .3 （12～30） months .There was no recurrence .[Conclusion]POEM has short and intermediate‐term efficacies for achalasia .However its long‐term outcomes require further studies .