经口内镜全层肌切开术与环形肌切开术治疗贲门失弛缓症临床疗效分析

Comparison of peroral endoscopic full-thickness myotomy and circular myotomy for achalasia

目的比较经口内镜全层肌切开术与环形肌切开术治疗贲门失弛缓症(achalasia,AC)的临床疗效。方法回顾性分析2012年8月至2014年12月东华医院收治的29例行经口内镜肌切开术AC患者的临床资料。其中16例为全层肌切开组(F-POEM),13例为环形肌切开组(C-POEM),分析两种治疗方式的临床疗效及并发症发生情况。结果 29例患者均成功实施POEM术,手术成功率为100%。FPOEM组与C-POEM组手术时间为(41.23±8.02)min和(50.75±9.07)min,差异有统计学意义(P<0.05),F-POEM组较C-POEM组手术时间平均缩短约10 min。F-POEM组和C-POEM组术后1月、6月及12月食管压力较术前均明显下降,差异均有统计学意义(P<0.05),两组食管压力在术后1月、6月和12月各时间点相互比较,差异无统计学意义(P>0.05)。以术后6个月内Eckardt评分≥4分考虑为手术失败,两组治疗有效率分别为100%(13/13)和93.75%(15/16),差异无统计学意义(P>0.05)。两组皮下气肿发生率分别为46.15%(6/13)和50.00%(8/16),两组气胸发生率为15.38%(2/13)和18.75%(3/16),差异均无统计学意义(P>0.05),C-POEM组术后发生反流性食管炎(3例)少于F-POEM组(5例),差异无统计学意义(P>0.05)。结论经口内镜全层肌切开术与环肌切开术治疗AC患者的短期疗效相当,并发症发生率相似,但全层肌切开术可缩短手术时问,不增加术后反流的发生。

Objective To compare and analyze the efficacy and safety of full-thickness peroral endoscopic myotomy and circular myotomy for patients with achalasia. Methods The clinical data of 29 patients with achalasia who were admitted in our hospital from August 2011 to December 2014 were retrospectively analyzed. Sixteen patients received full-thickness POEM（F-POEM）, the other 13 patients received circular myotomy（C-POEM）. The clinical efficacy and incidence of complications of the two groups were compared.Results POEM was successfully performed in all patients, with success rate being 100%. The operation time of the F-POEM group was（41.23 ± 8.02） minutes which was significantly shorter than（50.75 ± 9.07） minutes of C-POEM group（P〈0.05）. Esophageal pressure was significantly decreased 1 month, 6 months and 12 months after operation compared with preoperation in both F-POEM group and C-POEM group（P〈0.05）.However, the postoperative esophageal pressure had no statistical significance at 1 month, 6 months and 12 months between two groups（P〈0.05）. If the median Eckardt scores greater than or equal to 4 points within 6months was considered as surgery failure, the success rates of the F-POEM group and the C-POEM group were 100%（13/13）and 93.75%（15/16）,with no significant difference between two groups（P〉0.05）. The incidence of subcutaneous emphysema was 46.15%（6/13） in F-POEM group and 50%（8/16） in C-POEM group,and the incidence of pneumothorax was 15.38%（2/13） and 18.75%（3/16） respectively, there were no statistically significant difference（P〉0.05）. Postoperative reflux esophagitis in C-POEM group（3 cases） is less than F-POEM group（5 cases）（P〉0.05）.Conclusion The short-term efficacy and incidence of complications of F-POEM and C-POEM are comparable,while the operation time of F-POEM is shorter.