经口内镜下肌切开术治疗贲门失弛缓症的临床疗效

Clinical efficacy of peroral endoscopic myotomy in the treatment of achalasia

目的分析应用经口内镜下肌切开术(POEM)治疗贲门失弛缓症的临床疗效。方法贲门失弛缓症患者164例,139例接受POEM(P组),25例接受开胸Heller手术治疗(H组)。回顾性分析手术相关资料,采用Eckhardt评分和胃食管反流病问卷(GerdQ)评分等指标比较两组的临床疗效和并发症发生情况。结果与H组比较,P组手术时间和禁食时间短(P<0.01),住院时间少(P<0.05)。两组患者均随访2年以上,结果显示,P组和H组术后1年Eckhardt评分均少于术前[(2.0±1.5)分vs.(5.6±1.2)分和(2.6±1.8)分vs.(5.9±1.0)分](P<0.01)。P组术后1年Eckhardt评分稍低于H组,GerdQ评分≥8分者的比例稍高于H组(P>0.05)。术后1年,P组有效率96.4%,高于H组的72.0%(P<0.01)。P组和H组手术相关并发症发生率分别为46.04%和36.00%(P>0.05)。结论与开胸Heller手术比较,POEM治疗贲门失弛缓症疗效好,手术费时少,安全性高。

Objective To analyze the clinical efficacy of peroral endoscopic myotomy(POEM) in the treatment of achalasia.Methods A total of 164 patients with achalasia was treated with POEM(group P,139 cases) or Heller open chest surgery(group H,25 cases).The operation-related data were analyzed retrospectively.With Eckhardt score and GerdQ score, the clinical efficacy and adverse responses were compared between the two groups.Results Compared with group H,group P had shorter surgery time and fasting time, and less hospital stay(P<0.01 or P<0.05).The patients of two groups were followed up for more than two years, which showed that Eckhardt scores of group P and group H were significantly less one year after operation than those before surgery [(2.0±1.5) points vs.(5.6±1.2) points and(2.6±1.8) points vs.(5.9±1.0) points](P<0.01).Compared with group H one year after operation, Eckhardt score of group P was slightly less and the proportion of the patients with GerdQ score≥8 points was slightly higher(P>0.05).The effectiveness rate of one year after operation was significantly higher in group P than that in group H(96.4% vs.72.0%)(P<0.01).The incidence rates of surgery-ralated adverse responses in groups of P and H were 46.04% and 36.00%,respectively(P>0.05).Conclusion Compared with Heller open chest surgery, POEM in the treatment of achalasia has the advantages of better efficacy, shorter surgery time, and higher safety.