既往内镜或外科治疗的贲门失弛缓症患者再行经口内镜下肌切开术的临床研究

Peroral endoscopic myotomy for achalasia patients with and without prior endoscopic or surgical therapy

目的探讨既往有内镜或外科Heller肌切开术治疗史的贲门失弛缓症（AC）患者行经口内镜下肌切开术（POEM）治疗的有效性和安全性。方法回顾性分析2011年10月至2014年4月间行POEM治疗的164例AC患者的临床资料，根据POEM术前是否进行过内镜或外科Heller肌切开术，分为复治组和初治组，比较围手术期资料及术前、术后患者Eckardt评分变化情况。结果复治组58例，初治组106例。2组患者的POEM成功率分别为94．8％（55／58）和98．1％（104／106），差异无统计学意义（P=0．09）。所有患者中位随访时间17个月（6～30个月），术后症状明显改善，且术后1个月、12个月、24个月Eckardt评分（≤3分）较术前（4—11分）明显降低。随访期间复治组与初治组各有1例复发，症状缓解率98．7％（157／159）。复治组平均操作时间、住院天数及使用止血夹数量均多于初治组，分别是（70．8±20．7）min比（68．3±27．1）rain、（7．7±1．9）d比（7．5±2．6）d、（13．0±5．7）个比（12．7±5．6）个，但2组比较差异均无统计学意义（P〉0．05）。复治组和初治组并发症发生率分别是9．1％（5／55）、8．7％（9／104），差异也无统计学意义（P=0．93）。结论既往有内镜或外科治疗史的AC患者，POEM治疗仍然安全有效。

Objective To explore the clinical efficacy and safety of peroral endoscopic myotomy （POEM） for achalasia（AC） with or without prior endoscopic or surgical procedures. Methods The clinical data of 164 patients with severe achalasia who were admitted to our hospital from October 2011 to April 2014 were retrospectively analyzed. They were assigned to the retreatment group and the initial treatment group. The perioperative clinical data and Eckwardt scores before and after the operation were compared. Results A total of 164 patients were enrolled, 58 of whom already received prior endoscopic or surgical procedures for therapy were in the retreatment group, and the other 106 patients of whom hadn＇t any treatment for achalasia were in the initial treatment group. The success rates of POEM in two groups were 94. 8% （55/58） and 98.1% （104/106） ,with no significant difference （P 〉0. 05）. Median follow-up time was 17 months （ran- ging 6-30） , and the symptoms of patients relieved after treatment. The Eckardt scores at 1,12 and 24 months after the operation were ≤ 3, which were lower than that before operation （4-11 ）. During follow-up time, one recurrence happened in each group, and symptom relief rate was 98.7% （157/159）. The opera- tion time , hospital stay and number of Hemostatic clips in the retreatment group was more than that of initial group, （70. 8±20.7）min VS（68.3±27. 1） min, （7.7± 1.9）day VS （7.5 ±2.6）day,（13.0 ±5.7） piece VS （ 12. 7± 5.6） piece, respectively, with no significant difference （ P 〉 0.05 ）. The incidence of complications of the retreatment group and initial group were 9.1% （5/55） and 8.7 % （9/104）, with no sig- nificant difference （P = 0.93）. Conclusion POEM is an effective and safe method for the AC who have previous endoscopic or surgical treatment.