经口内镜下肌切开术治疗贲门失弛缓症的疗效分析(附30例报告)

Efficacy of peroral endoscopic myotomyin in treatment of achalasia: analysis of 30 cases

目的观察分析经口内镜下肌切开术(POEM)治疗贲门失弛缓症(AC)的临床疗效。方法收集2013年3月-2017年6月实施POEM的30例AC患者,评估手术前后Eckardt评分,记录食管动力测压结果、体质指数(BMI),总结手术完成情况、术后并发症及随访过程等资料。结果 30例患者行POEM治疗成功率100.0%,3例患者发现皮下气肿,2例有轻微胸骨后不适,4例有术后发热,1例发生迟发的上消化道出血。术后Eckardt评分(1.1±0.6)分与术前(5.2±1.3)分对比明显降低(P<0.05),术后BMI(22.6±2.9)kg/m^2与术前(19.2±1.8)kg/m^2相比较前增加(P<0.05)。食管动力学指标中,食管下括约肌静息压(LESP)术后(18.2±9.5)mm Hg对比术前(46.7±15.8)mm Hg明显降低(P<0.05),食管下括约肌完整松弛压(IRP)术后(10.5±2.5)mm Hg对比术前(22.8±8.3)mm Hg也明显下降(P<0.05),食管下括约肌长度(LESL)术后(2.5±0.5)cm对比术前(2.9±0.8)cm明显缩短(P<0.05)。食管上括约肌静息压(UESP)和食管上括约肌长度(UESL),手术前后差异均无统计学意义(P>0.05)。结论 POEM是治疗AC的有效手段,其短期疗效确切,且安全性相对较高,部分食管动力学指标较前改善,但其远期并发症及有效性还需大样本进一步随访。

Objective To observe the clinical efficacy of peroral endoscopic myotomy （POEM） in treatmentof achalasia of cardia （AC）. Methods 30 patients with AC were enrolled and treated with POEM from March2013 to June 2017. Results All the 30 cases underwent surgery of POEM successfully. There was 3 cases ofsubcutaneous emphysema, 2 cases of mild sternal discomfort, 4 cases of post-operative fever and 1 case of delayedhemorrhage in the upper gastrointestinal tract. The Eckardt score （1.1 ± 0.6） was significantly lower than that beforeoperation （5.2 ± 1.3） （P 〈 0.05）. Postoperative BMI （22.6 ± 2.9） kg/m2 was significantly higher than preoperative（19.2 ± 1.8） kg/m2 （P 〈 0.05）. Of the esophageal dynamic index, lower esophageal sphincter pressure （LESP）after operation （18.2 ± 9.5） mmHg was significantly lower than pre-operation （46.7 ± 15.8） mmHg （P 〈 0.05）.Integrated relaxation pressure （IRP） after operation （10.5 ± 2.5） mmHg was significantly lower than pre-operation（22.8 ± 8.3） mmHg （P 〈 0.05）. Length of lower esophageal sphincter （LESL） after operation （2.5 ± 0.5） cm wasshorter than pre-operation （2.9 ± 0.8） cm （P 〈 0.05）. Upper esophageal sphincter pressure （UESP） and length of upperesophageal sphincter （UESL） had no significant difference before and after operation （P 〉 0.05）. Conclusion POEM is an effective treatment for AC, its short-term effect is affirmed, and its safety is relatively high, part of esophagealdynamic indexes were improved. Long-term efficacy and complications of POEM still need large sample to furtherfollow-up.