贲门失弛缓症患者经口内镜下肌切开术后食管动力学变化

Change of esophageal motility in patients with achalasia after peroral endoscopic myotomy

目的探讨贲门失弛缓症患者经口内镜下肌切开术(POEM)前后食管动力学变化。方法回顾性分析解放军总医院消化内科2010年12月至2014年9月行POEM术的贲门失弛缓患者205例,其中共66例患者术前及术后食管测压检查完善,包括上食管括约肌静息压(UESP)、残余压(UESRP),下食管扩约肌静息压(LESP)、残余压(LESRP)、松弛率(LESRR),以及食管体部蠕动波,从而对POEM术与食管动力学的改善情况做以评估。对上述指标以x±s采集,采用SPSS 16.0统计软件行配对t检验。结果贲门失弛缓患者行POEM术后症状短期缓解率为95%,术后UESRP(16.468±21.672 vs 8.982±7.601,P=0.008)、LESP(34.678±14.908 vs 16.612±8.671,P=0.000)、LESRP(27.459±10.719 vs 11.313±6.792,P=0.000)较术前明显降低,LESRR较术前明显提高(0.211±0.146 vs 0.297±0.224,P=0.008)。但是POEM术对食管体部正常蠕动波无明确改善。结论 POEM术可有效降低贲门失弛缓患者上食管括约肌(UES)和下食管括约肌(LES)的压力,从而缓解临床症状,其远期效果及最终结论仍需进一步研究。

Objective To determine the outcome of peroral endoscopic myotomy （POEM）by esophageal manometry in patients with achalasia.Methods We conducted a retrospective study of 66 patients with complete data of esophageal manometry before and after operation out of 205 patients with achalasia undergoing POEM in Chinese PLA General Hospital from December 2010 to September 2014. Serving upper esophageal sphincter pressure （UESP ）,upper esophageal sphincter residual pressure （UESRP）,lower esophageal sphincter pressure （LESP）,lower esophageal sphincter residual pressure （LESRP）,lower esophageal sphincter relaxing rate （LESRR）,oesophageal body vermiculation while swallowing water before and after POEM.Results The short-term relief rate of symptoms in patients undergoing POEMwas 95%.There was a significant difference in the UESP（16.468 ±21.672 vs 8.982 ± 7.601,P =0.008）、LESP（34.678 ±14.908 vs 16.612 ±8.671,P =0.000）、LESRP（27.459 ±10.719 vs 11.313 ±6.792,P =0.000）and LESRR（0.211 ±0.146 vs 0.297 ±0.224,P =0.008）before and after POEM.However,POEMhad no effect on oesophageal body vermiculation.Conclusion POEMcan improve the outcome of esophageal motility in patients with achalasia;then a study on long-term effect and final conclusion is awaited.