经口内镜下食管环形肌切开术治疗贲门失弛缓症58例  

Peroral endoscopic myotomy for achalasia: Analysis of 58 cases

作　　者：马蓉霞[1,2] 张方信[1] 汪泳[1] 陈嘉屿[1] 康生朝[1] 王静舞[1] 王秀锋[1] 贾红梅[1] 

机构地区：[1]兰州军区兰州总医院消化科,甘肃省兰州市30050 [2]兰州大学第二临床医学院消化科,甘肃省兰州市730030

出　　处：《世界华人消化杂志》2014年第21期3095-3099,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨经口内镜下食管环形肌切开术(peroral endoscopic myotomy,POEM)治疗贲门失弛缓症(achalasia,AC)的可行性、安全性及临床预后.方法:回顾性分析2011-05/2013-06确诊为AC并接受POEM治疗的58例患者的临床资料.总结术中及术后并发症,患者吞咽困难症状(主观症状评分及Eckardt评分)、钡剂高度(时间吞钡检查)、电子胃镜检查及3、6、12、24 mo随访,了解吞咽困难的复发率和返流发生率等.结果:58例患者均成功接受POEM治疗,术中仅1例出现少量皮下气肿,平均术中出血量<10 mL,术后亦无迟发型出血、穿孔及脓胸等严重并发症;比较患者术前及术后平均主观症状评分(从10降至0.8)、Eckardt评分及时间吞钡钡剂高度均有显著差异(P<0.05);术后随访,生活质量全部改善,75%(43/58)的患者体质量平均增加3.7 kg(1-7 kg);58例3、6、12 mo及50例24 mo随访中,在3、6 mo各1例患者出现进食哽咽症状,经单次内镜下球囊扩张(endoscopic pneumatic dilation,EPD)后,患者Eckardt评分均为0,吞咽困难症状缓解,无返流发生.结论:本组研究结果表明POEM治疗AC是安全、微创、有效,值得推广.AIM： To assess the safety, feasibility and clinical efficacy of peroral endoscopic myotomy （POEM） in the treatment of achalasia. METHODS： Clinical data of 58 patients with AC who underwent POEM in our department from May 2011 to June 2013 were analyzed ret- rospectively. Intraoperative and postoperative complications, symptoms of dysphagia （subjec- tive symptom score and Eckardt score）, height of barium （cm） at 1, 2 and 5 min, and recurrence rate and the incidence of reflux evaluated by gastrointestinal endoscopy at 3, 6, 12, and 24 mo follow-ups were analyzed. RESULTS： All the 58 patients underwent POEM successfully. A small amount of sub- cutaneous emphysema was observed in only 1 case, and there were no mediastinal emphy- sema, pneumothorax, pneumoperitoneum or other complications. The estimated average blood loss was 〈 10 mL, and no serious postop- erative complications such as delayed bleeding, perforation and empyema occurred. Mean com- prehensive subjective symptom score decreased from 10 to 0.8 following the procedure, and there were significant differences （P 〈 0.01） be- tween pre and postoperative barium height and Eckardt score. During postoperative follow- up, there appeared an improvement in the life quality of patients. Approximately 75% （43/58） of patients gained weight by an average of 3.7 kg （1-7 kg）. Two patients had reflux symptoms, and endoscopy suggested esophagitis （modified Los classification LA-A in one case LA-B in the other）. Esophageal 24-h pH monitoring showed that prompt esophageal acid exposure time （more than 4.5% of the time pH value 〈 4） was 13.4%, of which 5.7% occurred in the standing position and 26.1% in the supine position, and the symptoms in all such patients were easily controlled by the usual dosage of proton pump inhibitors （PPI）. During the follow-up, two pa- tients experienced eating choking symptoms at 3 and 6 mo, respectively, and after single endo- scopic balloon dilatation （EPD）, Eckardt scores became 0, and the d

关 键 词：贲门失弛缓症 经口内镜下食管环形肌切开术 

分 类 号：R655.4[医药卫生—外科学]