经口内镜下肌切开术治疗60岁以上患者原发性贲门失弛缓症的单中心研究

A single-center research of peroral endoscopic myotomy for primary achalasia in patients over 60 yearsold

目的探究经口内镜下肌切开术(peroral endoscopic myotomy, POEM)对60岁以上原发性贲门失弛缓症(achalasia, AC)患者的治疗效果。方法回顾性分析2010年11月-2019年9月经解放军总医院消化内镜中心行POEM治疗的146例≥60岁老年组和146例18~59岁成年组患者资料, 对其基础资料、手术资料、手术相关并发症、手术疗效进行分析。结果 2组患者在性别、Ling分型、HRM分型与既往治疗方面差异均无统计学意义(P>0.05);292例患者均成功接受POEM治疗, 老年组和成年组临床成功(Eckardt评分≤3分)率分别为96.33%(105/109)和96.77%(90/93), 差异无统计学意义(χ^(2)=0.030, P>0.05);2组患者肌切开总长度差异无统计学意义[(7.09±2.49)cm比(7.12±2.24)cm, t=0.472, P>0.05];老年组有26例(17.81%)出现并发症, 成年组有21例(14.38%)出现并发症, 2组差异无统计学意义(χ^(2)=0.634, P>0.05);老年组与成年组患者术后住院时间差异无统计学意义[(12.61±9.69)d比(11.00±4.43)d, t=1.825, P>0.05]。老年组和成年组术后反流性食管炎发生率分别为43.33%(13/30)和51.52%(17/33), 差异无统计学意义(χ^(2)=0.422, P>0.05)。结论 POEM治疗60岁以上AC患者与成年患者疗效相当, 并发症发生率相当, POEM治疗60岁以上AC患者是安全有效的。

Objective To explore the therapeutic effect of peroral endoscopic myotomy(POEM)for primary achalasia(AC)in patients aged over 60 years.MethodsData of 146 patients aged≥60 years(the elderly group)and 146 patients aged 18-59 years(the adult group)who received POEM from November 2010 to September 2019 at the Digestive Endoscopy Center of PLA General Hospital were retrospectively analyzed.Baseline data,surgery data,surgery-related complications and surgery-related efficacy were compared.ResultsThere was no significant difference in gender,Ling classification,HRM classification or previous treatment between the two groups(P>0.05).All 292 patients successfully underwent POEM surgery.The clinical success(Eckardt score≤3)rates in the elderly group and the adult group were 96.33%(105/109)and 96.77%(90/93),respectively with no significant difference between the two groups(x^(2)=0.030,P>0.05).There was no significant dfference in the length of myotomy between the two groups(7.09±2.49 cm VS 7.12±2.24 cm,t=0.472,P>0.05).Complications occurred in 26 cases(17.81%)in the elderly group and 21 cases(14.38%)in the adult group with no significant difference between the two groups(x^(2)=0.634,P>0.05).There was no significant difference in the postoperative hospital stay(12.61±9.69 days VS 11.00±4.43 days,t=1.825,P>0.05)or the incidence of gastroesophageal reflux[43.33%(13/30)VS 51.52%(17/33),x^(2)=0.422,P>0.05]between the elderly group and the adult group.Conclusion The efficacy of POEM for AC patients over 60 years old is equivalent to that of adult patients,and the incidence of complications is similar.POEM is safe and effective for AC patients over 60 years old.