经口内镜下肌切开术与腹腔镜Heller手术治疗贲门失弛缓症的临床疗效对比  

Comparison of clinical effect between peroral esophageal myotomy and laparoscopic Heller myotomy for achalasia

作　　者：谈秋慧 谢军培[1] 韩曲 詹晓娟[1] 陈章兴[1] 曾伟[1] 戴益琛[1] 

机构地区：[1]中国人民解放军第174医院消化内科,福建厦门361003 [2]江西省丰城市人民医院普外科

出　　处：《胃肠病学和肝病学杂志》2015年第9期1104-1107,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：南京军区医学科技创新项目(MS090)

摘　　要：目的比较经口内镜下肌切开术(peroral esophageal myotomy,POEM)与腹腔镜Heller手术治疗贲门失驰缓症的临床疗效。方法收集中国人民解放军第174医院2004年1月-2013年2月收治的贲门失弛缓症患者,根据手术方式,分为POME组和腹腔镜Heller手术组(腹腔镜组),比较两组治疗后临床症状缓解率、食管最大宽度下降幅度、并发症发生率及复发率。结果共纳入60例贲门失驰缓症患者,POME组27例,腹腔镜组33例,术后随访1个月,两组症状均明显缓解,食管最大宽度下降幅度分别为(2.5±1.2)cm、(2.2±1.3)cm,两组相比,差异无统计学意义(P>0.05)。POEM组出现2例(7.4%)并发症,腹腔镜Heller手术组出现2例(6.1%)并发症,两组相比,差异无统计学意义(P>0.05)。随访1个月后POEM组出现2例(7.4%)胃食管反流病患者,随访1年2例(7.4%)复发,腹腔镜组术后未出现明显不适,两组术后并发症发生率和复发率相比,差异均无统计学意义(P>0.05)。结论腹腔镜Heller手术与POME治疗贲门失弛缓症有效性及安全性相当。Objective To compare the clinical effect of peroral esophageal myotomy （POEM） and laparoscopie Heller myotomy in treating patients with achalasia. Methods The patients with achalasia in the 174th Hospital of the Chinese PLA from Jan. 2004 to Feb. 2013 were collected, and divided into POME group and laparoseopic Heller myoto- my group （laparo seopic group） by operation mode. Clinical symptom remission rate, change of maximum esophagus width, complication rate and relapse rate between two groups were compared after treatment. Results Sixty patients with achalasia were selected. There were 27 patients in POME group and 33 patients in laparoscopic group. Symptoms in both groups of patients were obviously alleviate after one month, changes of maximum esophagus width in two groups separately were （2.5 -＋ I. 2） cm, （2.2 _＋ 1.3 ） cm, the difference was not statistically significant （ P 〉 0.05 ）. There were 2 cases （7.4%） of intraoperative complications in POME group and 2 cases （6.1%） in laparoscopic group, the difference was not statistically significant （P 〉 0.05）. There were 2 patients （7.4%） with gastroesophageal reflux dis- ease after follow-up one month and 2 patients （7.4%） relapsed in POEM group after one year, while the patients in laparoscopic group had no obvious discomfort after the operation, the differences of complication rate and relapse rate were not statistically significant （P 〉 0.05）. Conclusion Compared with laparoscopic Heller myotomy, POEM leads to similiar effective and safe clinical results in treating patients with achalasia.

关 键 词：贲门失弛缓症 经口内镜下肌切开术 腹腔镜Heller手术 临床疗效 

分 类 号：R571[医药卫生—消化系统]