经口内镜肌切开术对贲门失弛缓症的疗效分析  

Analysis of the therapeutic effect of peroral endoscopic myotomy for treatment of achalasia of cardia

作　　者：毛艳会 陈虹彬[1] 胡小三[2] 倪阵[1] 乔丽娟[1] 汤善宏[1] 徐辉[1] 曾维政[1] 蒋明德[1] 

机构地区：[1]成都军区总医院消化内科,四川成都610083 [2]泸州医学院,四川泸州646000

出　　处：《川北医学院学报》2016年第2期224-227,231,共5页Journal of North Sichuan Medical College

摘　　要：目的:分析经口内镜肌切开术(peroral endoscopic myotomy,POEM)对贲门失弛缓症治疗的疗效及预后。方法:选取我院消化内科确诊为贲门失弛缓症并接受POEM手术患者15例,比较患者术前、术后1个月及术后12个月的客观指标:食管腔扩张直径、食管下括约肌静息压(lower esophageal sphincter pressure,LESP)、食管下括约肌(lower esophageal sphincter,LES)长度和松弛率,及主观指标包括贲门失弛缓症临床症状评分系统(Eckardt评分)、胃食管反流问卷调查表(gastroesophageal reflux disease questionnaire,GERD Q)、吞咽困难评分量表、汉化版生活质量评分表(SF-36)。结果:15例患者顺利完成POEM,1例(6.7%)并发穿孔,3例(20%)见不同程度的纵膈气肿,2例(13.3%)发现轻微肺部感染,经保守治疗后恢复。术后1个月、及12个月主观指标及客观指标均显著优于术前(P<0.05)。结论:POME是治疗贲门失弛缓症较为安全、有效的方法,能显著改善患者吞咽困难及生活质量,值得临床推广。Objective： To analyze the efficacy of peroral endoscopic myotomy（ POEM） for treatment of achalasia of cardia（ AC）. Methods： A total of 15 patients with AC in of Cheng Du Military General Hospital who accepted POEM treatment were enrolled,We compare the preoperation,1 month and 12 months after POME about the objective indexes（ the inside diameter of dilated esophagus,lower esophageal sphincter pressure,the length and the relaxation ratio of LES） and the subjective indexes（ Eckardt score,the questionnaire of GERD,the rating scales of dysphagia and the Hanization score sheet of life quality）. Results： The POEM was successfully completed for all the 15 patients. Perforation occurred in 1 patient（ 1 /15,6. 7%）; the varying degrees of Mediastinal emphysema occurred in 3 patients（ 3 /15,20%）; and the mild lung infection occurred in 2 patients（ 2 /15,13. 3%）. All complications were healed after conservative treatment. The objective indexes and the subjective indexes of 1 month and 12 months after POME are all significantly improved compared with preoperation（ P 〈 0. 05）. Conclusion： POEM is a relatively safe and effective surgery,which can relieve dysphagia and improve the life quality significantly,and is also worth to be popularized.

关 键 词：经口内镜肌切开术 贲门失弛缓症 疗效分析 随访 

分 类 号：R571[医药卫生—消化系统]