腹腔镜Heller肌切开术与经口内镜下食管肌切开术治疗贲门失弛缓症的临床疗效对比

Comparison of clinical effect between laparoscopic Heller myotomy and peroral endoscopic myotomy for achalasia

目的比较腹腔镜Heller肌切开术(LHM)+Dor胃底折叠术和经口内镜下食管肌切开术(POEM)治疗贲门失弛缓症的临床疗效。方法回顾性分析徐州医科大学附属医院2014年1月至2018年12月期间收治的67例确诊为贲门失弛缓症患者的临床资料,其中19例采用LHM+Dor胃底折叠术治疗(LHM组),48例采用POEM治疗(POEM组),比较两种手术的临床疗效及安全性。结果2组患者的基线资料如性别、年龄、病程、体质量指数、术前Eckardt评分、术前食管最大直径及既往治疗史比较差异均无统计学意义(P>0.05)。2组患者的手术时间、术中出血量、术后3和12个月时的Eckardt评分、食管最大直径下降幅度、术后并发症(除胃食管反流外,P=0.029)及复发率比较差异均无统计学意义(P>0.05),但与LHM组比较,POEM组的总住院时间和术后住院时间更短(P<0.05)且住院总费用更少(P<0.05)。结论LHM与POEM均能有效缓解患者的临床症状,二者近期疗效与安全性相近,POEM术后恢复更快且具有良好的经济效益,但其术后胃食管反流发生率较高。

Objective To compare the clinical effect of laparoscopic Heller myotomy(LHM)combined with Dor fundoplication and peroral endoscopic myotomy(POEM)in treatment of patients with achalasia.Methods The clinical data of 67 patients with achalasia from January 2014 to December 2018 in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.Among them,19 patients received the LHM combined with Dor fundoplication(LHM group),48 patients received the POEM(POEM group).The clinical efficacy and safety of the two groups were compared.Results There were no significant differences in the baseline data such as the gender,age,course of disease,body mass index,preoperative Eckardt score,preoperative maximum diameter of esophagus,and previous treatment history between the two groups(P>0.05).There were no significant differences in the operation time,bleeding volume,the Eckardt points at 3 and 12 months after operation,the decrease degree of maximum diameter of esophagus,complications(except for gastroesophageal reflux,P=0.029),and recurrence rate between the two groups(P>0.05).The total hospitalization time,postoperative hospitalization time,and total hospitalization costs of the POEM group were lower than those of the LHM group(P<0.05).Conclusions Both LHM and POEM could effectively relieve clinical symptoms,short-term efficacy and safety of the two kinds of operations are similar.Postoperative recovery of POEM is fast and hospitalization cost is less,but incidence of gastroesophageal reflux is higher.