经口内镜下肌切开术治疗7例食管中段憩室的临床观察

Clinical observation of peroral endoscopic myotomy for mid‑esophageal diverticulum in 7 cases

探究经口内镜下肌切开术治疗食管中段憩室的有效性与安全性。从前瞻性数据库中回顾性纳入2014年4月—2019年9月在四川大学华西医院接受食管憩室经口内镜下肌切开术(diverticular peroral endoscopic myotomy,D‑POEM)治疗食管中段憩室的患者,使用适用于食管中段憩室的改良Eckardt评分系统评估憩室症状的严重程度,从临床成功情况、技术成功情况、并发症及复发情况等方面评价其有效性及安全性。共纳入7例食管中段憩室患者,D‑POEM治疗临床成功7例,技术成功7例,手术用时为16~70 min;2例发生轻微并发症,无严重并发症,无复发;随访时间为2~16个月,改良Eckardt评分患者中位得分由术前3分降至术后0分。初步认为D‑POEM确保了正常食管腔与食管憩室之间间隔肌的完全切开,是一种安全有效的治疗食管中段憩室的技术;改良Eckardt评分系统适用于食管中段憩室治疗前后的症状评价。

To investigate the effectiveness and safety of diverticular peroral endoscopic myotomy(D-POEM)for mid-esophageal diverticulum.Data of consecutive patients in the prospective database with mid-esophageal diverticulum who received D-POEM in West China Hospital,Sichuan University between April 2014 to September 2019 were collected.The modified Eckardt scoring system for mid-esophageal diverticulum was used to evaluate the severity of diverticular symptoms.The effectiveness and safety of D-POEM were evaluated in terms of clinical success,technical success,complications and recurrence.A total of 7 patients with mid-esophageal diverticulum were included.Clinical and technical success was achieved in all patients with operation time of 16-70 minutes.No serious complications(2 cases with minor complications)or recurrence occurred.The follow-up time was 2-16 months.The median modified Eckardt score decreased from 3 points before operation to 0 points after operation.It is preliminarily believed that D-POEM ensures a complete septotomy between normal esophageal lumen and esophageal diverticulum.It is a safe and effective technique for mid-esophageal diverticulum.The modified Eckardt scoring system is suitable for symptom evaluation before and after treatment of mid-esophageal diverticulum.