POEM治疗64例贲门失弛缓症临床疗效观察  

Clinical efficacy of peroral endoscopic myotomy in treatment of achalasia

作　　者：张彩凤[1,2] 聂占国[2] 游云[2] 孙金山[2] 于霞[2] 雷婷[2] 刘国伟[2] 

机构地区：[1]石河子大学医学院,新疆石河子832000 [2]兰州军区乌鲁木齐总医院消化内科

出　　处：《胃肠病学和肝病学杂志》2015年第6期716-719,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨经口内镜下肌切开术（peroral endoscopic myotomy,POEM）治疗贲门失弛缓症（achalasia,AC）的临床疗效。方法选取2012年2月-2014年3月兰州军区乌鲁木齐总医院确诊为AC并接受POEM治疗的64例患者,观察患者手术前后Eckardt评分及食管动力测压结果,评价手术疗效。结果 64例患者中63例成功完成POEM,无严重并发症,手术时间（81.2±20.1）min,黏膜下隧道切开长度（11.7±1.8）cm,环形肌切开长度长阶段为（9.2±0.8）cm,短阶段为（5.0±0.5）cm。行食管测压的23例患者术后食管下括约肌（LES）平均静息压（18.7±5.9）mm Hg,较术前（50.6±13.4）mm Hg明显降低（P〈0.01）;56例患者术后12~36个月随访Eckardt评分（1.4±1.0）较术前（7.0±2.1）明显降低（P〈0.01）。长阶段、短阶段环形肌切开临床疗效及Eckardt评分无差异（P〉0.05）。结论 POEM作为一项新兴微创技术,治疗AC短期临床疗效确切,可以迅速缓解患者吞咽困难等临床症状,长期疗效及远期并发症仍有待大样本随访及监测。Objective To investigate the clinical efficacy of peroral endoscopic myotomy （POEM） in treatment of achalasia （AC）. Methods Clinical data of 64 patients who diagnosed in Urumqi General Hospital of Lanzhou Military Region and received POEM treatment from Feb. 2012 to Mar. 2014 were collected. The Eckardt score and evaluation of esophageal manometry before and after surgery were observed. Results Sixty-three cases underwent surgery of POEM successfully, no major complication occurred, mean time of operation was （81.2 ± 20.1 ） min, submucosal tunnel inci- sion length was （ 11.7± 1.8） cm, circular muscle incision length of long section was （9.2 ± 0.8） cm, short section was （5.0 ± 0.5） cm. Eckardt score of 56 patients after 12 -36 months follow-up （1.4 ± 1.7） was significantly lower than before treatment （7.0 ± 2.1 ） （P 〈 0.01 ）. Lower oesophageal sphincter pressure of 23 cases after operation （ 18.7 ± 5.9） mmHg was significantly lower than befor operation （50.6 ± 13.4） mmHg （P 〈0.01 ）. The clinical effect was sig- nificant. Long, short circular cut of the clinical efficacy and Eckardt score had no difference （ P 〉 0.05 ）. Conclusion POEM as a new minimally invasive techniques, is safe and effective in the treatment of AC. Long-term efficacy and com- plications of POEM remain to be large sample follow-up and observation.

关 键 词：内镜 经口内镜下肌切开术 短阶段环形肌切开 贲门失弛缓症 疗效 

分 类 号：R571[医药卫生—消化系统]