不同亚型贲门失弛缓症患者食管测压特征比较及经口内镜下肌切开术后食管功能改变分析

Comparison of esophageal pressure characteristics in patients with different subtypes of achalasia and analysis of changes in esophageal function after POEM

目的观察不同亚型贲门失弛缓症(AC)患者食管测压特征以及经口内镜下肌切开术(POEM)术后食管功能改变情况。方法前瞻性选取2018年3月至2020年3月徐州市中心医院消化内科收治且行POEM术的AC患者32例。根据芝加哥分类标准分型,Ⅰ型(Ⅰ组)14例,Ⅱ型(Ⅱ组)18例,无Ⅲ型病例。比较两组患者的临床症状Eckardt评分,食管功能指标下括约肌长度(LESL)、食管下括约肌静息压(LESP)、食管下括约肌残余压(LESRP)、食管下括约肌松弛率(LESRR)。结果术前,两组Eckardt评分比较差异无统计学意义(P>0.05),术后1个月,Ⅱ组Eckardt评分为(1.11±0.32)分,明显低于Ⅰ组[(1.79±0.70)分],差异有统计学意义(P<0.05)。就食管测压而言,LESL在时间与组别上差异无统计学意义(P>0.05),术前,两组LESP、LESRR、LESRP比较,差异无统计学意义(P>0.05),术后1个月、术后3个月、术后6个月,Ⅱ组LESP[(18.54±5.75 vs.23.41±6.48;14.43±4.12 vs.19.76±6.02;11.25±2.79 vs.15.92±5.54)mmHg]、LESRP[(38.16±8.54 vs.45.78±10.56;31.46±8.11 vs.39.97±9.34;23.61±7.52 vs.36.94±8.67)mmHg]均明显低于Ⅰ组,LESRR[(32.53±6.27 vs.27.52±5.89;40.82±8.84 vs.32.55±7.19;51.11±10.95 vs.38.47±8.82)%]均明显高于Ⅰ组,差异均有统计学意义(P<0.05)。结论Ⅰ型、Ⅱ型AC患者POEM术前食管测压基本指标(LESL、LESP、LESRR、LESRP)无显著差异,而POEM术后Ⅱ型AC患者食管功能改善更为明显,因此,明确诊断并分型,合理选择治疗方案或有利于预后。

Objective To observe the characteristics of esophageal pressure measurement in patients with different subtypes of achalasia and the changes in esophageal function after peroral endoscopic myotomy(POEM).Methods From March 2018 to March 2020,32 AC patients who were admitted to the Department of Gastroenterology in Xuzhou Central Hospital and underwent POEM were prospectively selected.According to the Chicago classification standard,there were 14 cases of typeⅠ(groupⅠ),18 cases of typeⅡ(groupⅡ),and no typeⅢcases.comparing the two groups of clinical symptoms Eckardt score,esophageal function index lower sphincter length(LESL),lower esophageal sphincter resting pressure(LESP),lower esophageal sphincter residual pressure(LESRP),lower esophageal sphincter relaxation rate(LESRR).Results In terms of clinical symptoms,there was no significant difference in Eckardt scores between the two groups before surgery(P>0.05).At 1 month after surgery,the Eckardt score in groupⅡwere(1.11±0.32)points,which were significantly lower than those of groupⅠ[(1.79±0.70)points],and the differences were statistically significant(P<0.05).In terms of esophageal pressure measurement,LESL had no significant difference in time and group(P>0.05).Before surgery,there was no significant difference in LESP,LESRR,and LESRP between the two groups(P>0.05).1 month after operation,3 months after operation,and 6 months after operation,LESP in groupⅡ[(18.54±5.75 vs.23.41±6.48;14.43±4.12 vs.19.76±6.02;11.25±2.79 vs.15.92±5.54)mmHg],LESRP[(38.16±8.54 vs.45.78±10.56;31.46±8.11 vs.39.97±9.34;23.61±7.52 vs.36.94±8.67)mmHg]were significantly lower than groupⅠ,LESRR[(32.53±6.27 vs.27.52±5.89;40.82±8.84 vs.32.55±7.19;51.11±10.95 vs.38.47±8.82)%]were significantly higher than those in groupⅠ,and the differences were statistically significant(P<0.05).Conclusion There is no significant difference in the basic indexes of esophageal pressure measurement(LESL,LESP,LESRR,LESRP)in patients with type I and typeⅡAC before POEM,but the esophageal function of typeⅡAC patients improves more significantly after POEM.Therefore,the diagnosis and classification are clear,A reasonable choice of treatment plan may be beneficial to the prognosis.