经口内镜下肌切开术治疗贲门失弛缓症术后3年疗效评估  

Clinical efficacy assessment of peroral endoscopic myotomy therapy in patients with achalasia of cardia followed up for three years

作　　者：晋弘[1] 张莉莉[1] 郑忠青[1] 王涛[1] 赵威[1] 李婷[1] 吴兰兰[1] 王邦茂[1] 

机构地区：[1]天津医科大学总医院消化科,300052

出　　处：《中华消化杂志》2015年第4期217-220,共4页Chinese Journal of Digestion

基　　金：国家自然科学基金（81370492）

摘　　要：目的 观察经口内镜下肌切开术（POEM）治疗贲门失弛缓症术后3年的疗效,并探讨食管高分辨率测压和食管钡餐造影在评价POEM疗效中的价值.方法 收集2011年4月至2013年12月确诊为贲门失弛缓症并接受POEM治疗者58例,分别在术前和术后1个月、6个月、1年、2年、3年时,采用食管高分辨率测压检测下食管括约肌压力（LESP）、下食管括约肌松弛率（LESRR）、4s完整松弛压（4sIRP）、食管体部有效蠕动比例,采用食管钡餐造影检查测定食管最大径,通过Eckardt评分评价疗效.正态分布的计量资料行t检验.非正态分布的计量数据行秩和检验.采用Pearson积矩进行相关性分析.结果 58例贲门失弛缓症患者的POEM均顺利完成.患者术后1个月、6个月、1年、2年、3年时的Eckardt评分分别为0（0∽1）分、1（0∽2）分、1（0∽2）分、1（0∽4）分、2（0∽4）分,与术前[7（5∽9）分]比较,差异均有统计学意义（Z--4.134、4.124、-4.135、-4.121、-3.656,P均＜0.05）.患者术后1个月、6个月、1年、2年、3年时的LESP、LESRR、4sIRP与术前相比差异均有统计学意义（tLESP=4.968、6.301、5.757、4.716、5.608,tLESRR=5.364、-5.080、-4.965、4.755、4.348,t4sIRP=6.334、8.422、7.423、6.507、5.627,P均＜0.05）.患者术后1个月、6个月、1年、2年、3年时的食管最大径分别为（3.51±1.27） cm、（3.47±1.26） cm、（3.60±1.26） cm、（3.66±1.53） cm、（3.82±0.90） cm,与术前[（6.29±1.69） cm]相比差异均有统计学意义（t=4.898、6.116、4.452、4.650、4.187,P均＜0.05）.术后3年时食管最大径与Eckardt评分间、4sIRP与Eckardt评分间、4sIRP与食管最大径间均具相关性（r=0.635、0.844、0.729,P均＜0.05）.结论 POEM治疗贲门失弛缓症的短中期疗效佳.食管高分辨率测压和钡餐造影检查均可客观反映POEM疗效.Objective To observe the clinical efficacy of peroral endoscopic myotomy （POEM） in patients with achalasia of cardia followed up three years and assess the value of high resolution manometry （HRM） and esophageal barium meal in assessment of POEM therapy.Methods From April 2011 to December 2013,58 patients diagnosed as achalasia of cardia and accepted POEM therapy were collected.Before operation,at one month,six months,one year,two years and three years after operation,low esophageal sphincter pressure （LESP）,low esophageal sphincter relaxation rate （LESRR）,four seconds integrity relaxation pressure （4sIRP） and proportion of effective esophageal body peristalsis were detected by HRM; maximum diameter of esophageal was examined by esophageal barium meal and the efficacy was evaluated with Eckardt score system.The t test was performed for normal distributed measurement data.Rank sum test was used for non normal distributed measurement data.Pearson product moment was performed for correlation analysis.Results POEM was successfully completed in 58 patients with achalasia of cardia.At one month,six months,one year,two years and three years after operation,the Eckardt score was 0 （0 to 1）,1 （0 to 2）,1 （0 to 2）,1 （0 to 4）,2 （0 to 4）,respectively,compared with that of before operation （7,5 to 9） and the differences were statistically significant （Z=-4.134,-4.124,-4.135,-4.121 and-3.656,all P〈0.05）.The differences in LESP,LESRR and 4sIRP between before operation and at one month,six month,one year,two years and three years after operation were statistically significant （tLESP =4.968,6.301,5.757,4.716 and 5.608; tLEsRR =-5.364,-5.080,-4.965,4.755 and-4.348; t4sIRP=6.334,8.422,7.423,6.507 and 5.627; all P〈 0.05）.At one month,six month,one year,two years and three years after operation,the maximum diameter of esophageal was （3.51±1.27） cm,（3.47±1.26） cm,（3.60±1.26） cm,（3.66±1.53） cm and （3.82±0.90） cm,respectively,compared with that before operat

关 键 词：贲门失弛缓症 经口内镜下肌切开术 高分辨率测压 钡餐造影 

分 类 号：R656.6[医药卫生—外科学]