经口内镜下肌切开术治疗贲门失弛缓症的初探  

Peroral endoscopic myotomy for achalasia

作　　者：周平红[1] 姚礼庆[1] 蔡明琰[1] 钟芸诗[1] 任重[1] 徐美东[1] 陈巍峰[1] 秦文政[1] 胡健卫[1] 李亮[1] 刘靖正[1] 王萍[1] 秦新裕[1] 

机构地区：[1]复旦大学附属中山医院内镜中心复旦大学内镜诊疗研究所复旦大学上海医学院外科学系,上海200032

出　　处：《中华消化内镜杂志》2011年第2期63-66,共4页Chinese Journal of Digestive Endoscopy

基　　金：上海市科委医学引导类计划项目（10411962300）

摘　　要：目的探讨经口内镜下肌切开术（POEM）治疗贲门失弛缓症（AC）的疗效和可行性。方法研究2010年8月至2010年12月确诊为AC并接受POEM治疗的8例患者的临床资料。患者年龄16～62岁，平均43岁，病程2-20年，平均8．4年。POEM的主要步骤包括：食管黏膜层切开；分离黏膜下层，建立黏膜下“隧道”；胃镜直视下切开环形肌；金属夹关闭黏膜层切口。结果8例患者均成功接受POEM术，手术时间45-115min，平均68．5min，黏膜下隧道长度8～13cm，平均9．5cm，环形肌切开长度7～11cm，平均8．5cm，无1例出现与POEM相关的严重并发症。术后随访1～4个月，平均2．5个月，7例吞咽困难明显得到解除；1例术后15d出现进食困难及呕吐，胃镜检查发现黏膜下窦道形成，行内镜下窦道切开。结论作为一种新的微创治疗方法，POEM治疗AC短期疗效肯定，可以迅速解除AC患者吞咽困难，但其长期疗效及远期并发症仍有待随访观察。Objective To evaluate the efficacy and the feasibility of peroral endoscopic myotomy （POEM） for aehalasia （AC）. Methods The clinical data of 8 patients diagnosed as having AC and receiving POEM at our center from August 2010 to December 2010 were reviewed. The patients were 16-62 years old, mean 43yr, whose disease courses lasted for 2-20 years, mean 8.4 years. The key procedures of POEM were as the following, esophageal mucosal incision, submucosal tunneling by endoscopic submueosal dissection （ESD） , endoscopic myotomy of the circular muscle and closure of mucosal entry by hemostatic clips. Results All the 8 patients underwent POEM successfully. The mean operation time was 68.5 min （ ranging 45-115 min）. The mean submucosal tunneling length was 9.5 cm （ ranging 8-13 cm）. The average length of endoscopic myotomy of inner circular muscle was 8.5cm （ ranging 7-11 cm）. No severe complications related to POEM occurred. Patients were followed up for 1-4 months （ mean 2.5 months）. Dysphagia was relieved significantly during the follow-up in 7 patients. But dysphagia and vomiting re-occurred in one patient 15 days after the operation. Endoscopy revealed a submucosal fistula, which was managed by incision. Conclusion As a new minimally invasive therapy for AC, POEM is very effective to relieve dysphagia in a short term. However, further observation is needed to evaluate long-term efficacy and complications.

关 键 词：吞咽障碍 食管失弛症 内窥镜 治疗 

分 类 号：R571[医药卫生—消化系统]