经口内镜下食管憩室肌切开术治疗食管憩室的疗效分析

Efficacy of peroral endoscopic myotomy for esophageal diverticulum

目的探讨经口内镜下食管憩室肌切开术治疗食管憩室的中远期疗效以及术后憩室复发的危险因素。方法对2016年5月1日—2019年8月1日在东南大学附属中大医院接受经口内镜下食管憩室肌切开术治疗的31例食管憩室病例进行回顾性研究,主要观察术后Eckardt评分、治疗成功率和复发率,并采用多因素Logistic回归模型分析术后憩室复发的独立危险因素。结果31例均顺利完成经口内镜下食管憩室肌切开术,术后随访(30.6±11.1)个月(20~63个月)。31例术前Eckardt评分(8.2±2.4)分,术后1个月(1.4±0.7)分,术后6个月(1.4±1.1)分,术后12个月(1.3±1.1)分,术后24个月(1.3±0.9)分,与术前比较,术后各随访时间点的Eckardt评分均有明显下降(P<0.001)。术后随访1、6、12、24个月的治疗成功率分别为96.8%(30/31)、90.3%(28/31)、90.3%(28/31)和90.3%(28/31)。有3例复发,总复发率为9.7%(3/31)。Logistic回归分析结果显示,病程(P=0.038,OR=1.041,95%CI:1.002~1.080)和术前Eckardt评分(P=0.024,OR=2.299,95%CI:1.117~4.728)是影响术后憩室复发的独立危险因素。结论经口内镜下食管憩室肌切开术治疗食管憩室的中远期疗效理想,但病程长、术前Eckardt评分高者易复发。

Objective To investigate the medium-and long-term efficacy of peroral endoscopic myotomy(POEM)for esophageal diverticulum and the risk factors for postoperative recurrence.Methods A retrospective study was conducted on 31 cases of esophageal diverticulum who were treated by POEM in Zhongda Hospital,Southeast University from May 1st 2016 to August 1st 2019.The Eckardt score,the operative success rate,and the recurrence rate after the operation were observed and recorded.Multivariate logistic regression analysis was performed to explore the risk factors for postoperative recurrence.Results POEM was successfully completed in all 31 patients,who were followed up for 30.6±11.1 months(20-63 months).The Eckardt score before the operation was 8.2±2.4,and was 1.4±0.7,1.4±1.1,1.3±1.1,and 1.3±0.9 at 1,6,12 and 24 months,respectively after the operation,which significantly decreased at all follow-up time points(P<0.001).The success rates at 1,6,12,and 24 months after the operation were 96.8%(30/31),90.3%(28/31),90.3%(28/31)and 90.3%(28/31),respectively.Three patients suffered symptom relapse,with an overall recurrence rate of 9.7%(3/31).Logistic regression analysis showed that the disease duration(P=0.038,OR=1.041,95%CI:1.002-1.080)and preoperative Eckardt score(P=0.024,OR=2.299,95%CI:1.117-4.728)were risk factors for postoperative recurrence of POEM.Conclusion POEM is safe and effective for esophageal diverticulum.Patients with long disease duration and high preoperative Eckardt score are associated with recurrence.