改良经口内镜下肌切开术在治疗贲门失弛缓症中的应用研究（含视频）

Clinical application of modified peroral endoscopic myotomy to treatment of achalasia（ with video）

目的比较改良经口内镜下肌切开术（Liu—POEM）与传统POEM在治疗贲门失弛缓症中的差异。方法采用回顾性研究方法，选择30例完成Liu-POEM的患者和应用Liu-POEM之前近期完成传统POEM的30例患者为研究对象，通过对比两种术式的总手术时间、术后并发症及症状评分（Eckardt评分）来评价Liu-POEM的安全性和有效性。结果Liu-POEM平均总手术时间为（27．13±11．42）min，平均肌切开时间为（13．20±5．09）min；术后无患者出现纵隔及皮下气肿，无发热。传统POEM平均总手术时间为（51．22±25．63）min，平均肌切开时间为（11．18±7．61）min；术后有3例（10％）患者出现皮下气肿，未经特殊治疗，术后2d自行吸收；1例患者术后发热1d，最高体温37．6℃，物理降温后体温恢复正常。所有患者术后Eckardt评分〈3分。术后随访3-12个月，均无远期并发症发生。结论Liu-POEM具有操作技术简单，手术时间短，手术创伤小的优点。

Objective To compare the difference between modified peroral endoscopic myotomy （Liu-POEM） and conventional POEM for achalasia. Methods Thirty aehalasia patients treated with Liu- POEM and 30 with conventional POEM were enrolled. A retrospective study was performed to compare the conventional POEM and Liu-POEM procedures by evaluating total operation time, postoperative complications and symptoms（ Eckardt score）. Results The average total operation time of Liu-POEM was 27. 13 ± 11.42 min and the average myotomy time was 13.20±5.09 min. There was no pneumomediastinum, subcutaneous emphysema or fever. The average total operation time of conventional POEM was 51.22 ± 25.63 min. The average myotomy time was 11.18±7.61 min. There were three cases （ 10% ） of subcutaneous emphysema but recovered after two days without any special treatment. One patient who underwent conventional POEM had fever（ the highest temperature was 37. 6℃ ）and his temperature subsided to normal after physical cooling in one day. Postoperative Eckardt scores of patients were all less than 3. After postoperative follow-up of 3 to 12 months, no complications occurred in any patient. Conclusion Liu-POEM is a modified approach to treat achalasia, advantageous over conventional POEM in more simplified operation procedure, shorter operation time and less invasiveness.