经口内镜下肌切开术治疗贲门失弛缓症38例

Achalasia of cardia treated by peroral endoscopic myotomy in 38 cases

目的探讨经口内镜下肌切开术治疗贲门失弛缓症的效果。方法回顾性分析38例贲门失弛缓症患者（观察组）经口内镜下肌切开术的治疗效果，并与37例同期行开胸Heller手术患者（对照组）进行对比，观察比较两组手术情况（术中出血量、术后进食及出院时间）、手术前后贲门失弛缓症临床症状评分系统（ECKARDT）评分及食管动力学各指标[食管下括约肌4 s完全松弛压（4 s IRP）、食管下括约肌静息压（LESP）]变化情况，统计两组并发症发生情况。结果观察组术中出血量、术后进食时间及出院时间均少于对照组，差异有统计学意义（P〈0.05）；术后3个月观察组ECKARDT评分及4 s IRP、LESP均小于对照组，差异有统计学意义（P〈0.05）；观察组并发症发生率为5.26%（2/38），低于对照组的24.32%（9/37），差异有统计学意义（P〈0.05）。结论经口内镜下肌切开术可改善贲门失弛缓症患者的食管动力学，减少术中出血量，缩短术后进食及出院时间，降低并发症发生率。

ObjectiveTo investigate the effect of peroral endoscopic myotomy on achalasia of cardia.MethodsThe therapeutic effects of peroral endoscopic myotomy on 38 patients with achalasia of cardia （observation group） were retrospectively analyzed, and were compared with those of 37 patients who underwent open chest Heller operation （control group）. The operation conditions （intraoperative bleeding, postoperative feeding and discharge time）, the scores of clinical symptom scoring system for achalasia of the cardia （ECKARDT） before and after surgical treatment and esophageal motility indexes [4 s integrated relaxation pressure （4 s IRP） of the lower esophageal sphincter, resting lower esophageal sphincter pressure （LESP）] were observed and compared between two groups.ResultsThe intraoperative bleeding, postoperative feeding and discharge time in observation group were less than those in control group （P〈0.05）. The ECKARDT score, 4 s IRP and LESP in observation group were less than those in control group 3 months after operation （P〈0.05）. The incidence of complications in observation group was 5.26% （2/38）, which was lower than that in control group [24.32% （9/37）], P〈0.05.ConclusionsPeroral endoscopic myotomy in patients with achalasia of cardia can improve esophageal motility, reduce intraoperative blood loss, shorten the postoperative fasting time and discharge time, and reduce the incidence of complications.