经口内镜下肌切开术对贲门失弛缓症患者反流症状的影响

Effect of Peroral Endoscopic Myotomy on Reflux Symptoms in Patients With Achalasia

背景:贲门失弛缓症(AC)患者接受经口内镜下肌切开术(POEM)前后均会存在反流症状,但机制并不完全一致。目的:探讨POEM对AC患者反流症状的影响。方法:纳入2011年5月—2018年7月南京医科大学第一附属医院收治的接受POEM治疗的84例AC患者,根据是否存在反流症状分为术前反流组、术前无反流组,或术后反流组、术后无反流组,分别比较POEM术前、术后症状、食管高分辨率测压结果等指标。结果:接受POEM治疗后,AC患者下食管括约肌静息压(LESP)、完整松弛压(IRP)、Eckardt评分较术前明显降低(P<0.05)。与术前无反流组相比,术前反流组食管长度明显增加(P<0.001),术后Eckardt评分显著降低(P=0.039),两组术前、术后LESP、IRP相比均无明显差异。术后反流组术前反流症状发生率与术后无反流组无明显差异,两组术后LESP、IRP亦无明显差异。结论:AC患者POEM术前反流可能源自食管内食物潴留,术前反流者的POEM疗效较好。术后反流症状的发生可能与LESP无关,而与食管体部动力异常或食管高敏感有关。

Background:Achalasia patients may have reflux symptoms before and after peroral endoscopic myotomy(POEM),the mechanism is not completely consistent.Aims:To investigate the effect of POEM on reflux symptoms in patients with achalasia.Methods:Eighty-four achalasia patients underwent POEM from May 2011 to July 2018 at the First Affiliated Hospital of Nanjing Medical University were enrolled.According to whether they had reflux symptoms before or after POEM,the patients were divided into preoperative reflux group,preoperative non-reflux group or postoperative reflux group,and postoperative non-reflux group.Symptoms and parameters of high-resolution manometry before or after POEM were compared,respectively.Results:After POEM,the lower esophageal sphincter pressure(LESP),integrated relaxation pressure(IRP),Eckardt score in patients with achalasia were significantly decreased(P<0.05).Compared with preoperative non-reflux group,length of esophagus was significantly longer(P<0.001)and postoperative Eckardt score was significantly decreased(P=0.039)in preoperative reflux group.However,no significant differences in preoperative or postoperative LESP and IRP were found between the two groups.No significant differences in the incidence of preoperative reflux,postoperative LESP and IRP were found between postoperative reflux group and postoperative non-reflux group.Conclusions:The preoperative reflux symptom of achalasia patients may be caused by retention of food in esophagus.The preoperative reflux symptom may predict the better efficacy of POEM.Postoperative reflux symptom may be not correlated with LESP,but related with dysmotility of esophageal body or esophageal hypersensitivity.