经口内镜下肌切开术与经胸Heller术治疗贲门失弛缓症的临床疗效对比

Comparison of clinical effect between peroral endoscopic myotomy and Heller myotomy for achalasia

目的对比分析贲门失弛缓患者经口内镜下肌切开术(POEM)与经胸食管贲门部黏膜外肌层切开手术(即Heller术)的临床疗效及安全性。方法回顾性研究2012年1月-2014年10月该院78例确诊为贲门失弛缓症患者。其中,接受POEM术患者为42例,接受Heller术患者36例,观察并对比两组患者术后症状缓解情况、食管下段括约肌(LES)静息压力、Eckardt评分、术中和术后并发症发生率、手术时长、住院时间及住院费用等。结果两组患者术后均获得明显的临床缓解,POEM组患者的并发症发生率、Eckardt评分及LES静息压力和Heller术组相比差异无统计学意义(P>0.05)。而POEM组患者的手术耗时、住院时长及住院费用均明显低于Heller术组(P<0.05)。结论 POEM作为一种近期疗效显著的内镜微创手术方式,与外科手术疗效相当,对患者造成的创伤小,痛苦小,使患者耐受性好,住院时间及住院费用减少,值得推广。

Objective To compare the clinical effect and safety of peroral endoscopic myotomy （POEM） with surgical therapy in treatment of esophageal achalasia. Methods 78 patients diagnosed as esophageal achalasia from January 2012 to October 2014 were enrolled in the study and divided into POME group and Heller group. There were 42 patients in POEM group and 36 patients in Heller group. The clinical symptom remission rate, LES resting pressure, Eckardt scores, complication rate, length of hospital stay and the hospitalization expenses were analyzed between the two groups. Results The patients in POEM group and Heller group both got clinical remissions after the treatment. There was no statistical difference in the rate of complication occurrence, Eckardt scores and LES resting pressure between the two groups. Patients in POEM group had shorter operation time, hospital stay and less expenses compared with the Heller group. Conclusions Compared with Heller group, the POEM group has the similar curative effect in treatment of esophageal achalasia. The POEM as a minimally invasive surgery has the advantages of less pain and trauma, shorter hospital stay, well tolerated and low cost. Therefore, the POEM is worth to be popularized and applied in treating esophageal achalasia.