高分辨率测压评价贲门失弛缓症患者临床和食管动力学特征的研究

The value of high resolution manometry to evaluate clinical characteristics and esophageal dynamic of patients with achalasia

目的应用高分辨率食管测压评价未经治疗的贲门失弛缓症患者的临床和食管动力学特征，以及初次治疗的效果。方法纳入2012年1月至2016年6月就诊的贲门失弛缓症患者，收集患者的病史、临床症状、内镜、食管X线造影、高分辨率食管测压以及治疗情况的数据并进行分析。结果共入组133例患者，32例（24．O％）为Ⅰ型，84例（63．2％）为Ⅱ型，17例（12．8％）为Ⅲ型。Ⅰ型和Ⅱ型反流症状更重（P=0．020），与Ⅰ型相比，Ⅱ型和Ⅲ型胸痛更明显（P=0．006），Ⅱ型（P=0．015）和Ⅲ型（P=0．023）的下食管括约肌静息压更高。整合松弛压在3个亚型相似（P=0．158）。45例接受内镜下球囊扩张术（PD），47例接受经口内镜下肌切开术（POEM），在3个亚型中，POEM短期（6个月）治疗的成功率均高于PD，但是仅在Ⅲ型差异具有统计学意义（90．0％比40．0％，P=0．041）。结论不同亚型贲门失弛缓症患者的临床表现和食管动力学特点不同，Ⅲ型患者建议采用POEM治疗。

Objective To evaluate the clinical and esophageal dynamics characteristics, and initial treatment effect of patients with untreated achalasia using high resolution manometry. Methods From January 2012 to June 2016, patients newly diagnosed with achalasia were retrospectively recruited. Clinical information, endoscopy and X-ray findings, manometric variables and treatment outcomes were collected and compared among manometric subtypes. Results Among 133 patients with achalasia, 32 （24. 0%） were classified as type Ⅰ, 84 （63.2%） as type Ⅱ and 17 （12. 8%） as type Ⅲ. Compared with the type Ⅲ, the symptom of regurgitation was more common in the types Ⅰ and type Ⅱ achalasia patients （P= 0. 050）. While compared with the type Ⅰ, the score of chest pain was higher in the patients with type Ⅱ and type Ⅲ （P= 0. 006）, as well as the basal lower esophageal sphincter pressure （P= 0. 015, P=0. 023 for type Ⅱ and type Ⅲ, respectively）. Integrated relaxation pressure was similar among the 3 subtypes （P = 0. 158）. Forty- five and 47 patients received pneumatic dilation （PD） and peroral endoscopic myotomy （POEM） respectively, and all of the patients were followed-up for at least 6 months. The success rate was higher in the POEM group than that of the PD group in all the 3 manometric subtypes, but only the difference between POEM and PD in the type Ⅲ was statistically significant （90.0% VS 40.0%, P = 0.041 ）. Conclusion The clinical characteristics and treatment response are different among the 3 achalasia subtypes. Patients with type Ⅲ achalasia are probably the best candidates for POEM.