经口内镜括约肌切开术治疗贲门失弛缓症的有效性及安全性分析

Efficacy and safety of peroral endoscopic myotomy for patients with achalasia

目的:分析经口内镜括约肌切开术(POEM)治疗贲门失弛缓症(AC)的近期及远期疗效,探讨POEM术的安全性。方法:回顾性分析行POEM治疗的177例AC患者的临床及随访资料。分析Eckardt评分、食管下括约肌(LES)压力变化。采用Kaplan-Meier法计算治疗有效率。结果:POEM术后,随访3、12、24、36、48、60、72及84个月的治疗成功率(Eckardt评分≤3分)分别为98.3%、97.7%、97.1%、95.6%、94.6%、93.2%、90.7%及81.6%。术后Eckardt评分较术前均显著下降。共有11例POEM手术失败及复发(Eckardt评分≥4分),无一例发生严重的围手术期并发症。远期并发症中,症状性胃食管反流病(GERD)15例(8.5%),且通过大剂量质子泵抑制剂(PPI)可有效控制。结论:POEM治疗AC的有效率随着时间的推移而降低,但术后72~84个月的疗效依旧较理想。POEM是治疗AC的一种安全且疗效良好持久的方法。

Objective:To evaluate the short-term and long-term efficacy and safety of peroral endoscopic myotomy(POEM)for patients with achalasia.Method:Prospective data collected from 177 patients with achalasia who underwent POEM were retrospectively analyzed.The Eckardt score and lower esophageal sphincter pressure changes were analyzed.Kaplan Meier method was used to draw the survival curve of the patients with successful follow-up.Cox regression analysis was used to analyze the risk factors of treatment failure and recurrence.Results:The clinical success rate(Eckardt score≤3 points)was 98.3%,97.7%,97.1%,95.6%,94.6%,93.2%,90.7%and 81.6%at the follow-up time points of 3,12,24,36,48,60,72 and 84 months,respectively.The postoperative Eckardt scores at different follow-up time points were significantly lower than those before operation.There were 11 cases of failure and recurrence of POEM(Eckardt score≥4).No serious perioperative complications were found.During the long-term follow-up period,the incidence of symptomatic gastroesophageal reflux disease(GERD)was 8.5%(n=15),which could be effectively controlled by PPI.Conclusion:Although the clinical success rate of POEM is decreased over time,POEM is safe and effective in treating achalasia and has a favorable long-term efficacy.