经口内镜下肌切开术治疗贲门失弛缓症中长期疗效分析  

Analysis of Mid-and-Long Term Efficacy of Peroral Endoscopic Myotomy for Esophageal Achalasia

作　　者：叶院宁 陆恒[1] 孙文荣[1] 余纳[1] 张钰萍[1] 汪芳裕[1] 

机构地区：[1]南方医科大学金陵医院(南京军区南京总医院)消化内科,210002

出　　处：《胃肠病学》2016年第6期336-339,共4页Chinese Journal of Gastroenterology

基　　金：国家自然科学基金(81270453)

摘　　要：背景：经口内镜下肌切开术（POEM）是治疗贲门失弛缓症（EA）新的内镜微创技术，临床研究证实其用于治疗EA安全、有效，短期疗效肯定，但关于POEM治疗EA中长期疗效的报道尚少。目的：探讨POEM治疗EA的中长期疗效。方法：回顾性分析2012年7月-2013年12月于南京军区南京总医院消化内科接受POEM治疗并定期随访的41例EA患者，观察其临床症状Eckardt评分、食管最大直径和下食管括约肌压力（LESP）变化以及术中、术后并发症和复发情况。结果：41例EA患者均成功完成POEM，手术时间35～125min，平均（69．5±20．6）min，平均住院时间为3．5d。术后随访19～36个月，平均26．3个月。与术前相比，术后随访期间患者Eckardt评分、食管最大直径、LESP均显著降低（P〈0．05）。手术并发症发生率为14．6％（6／41），手术有效率为95．1％（39／41），复发率为2．4％（1／41）。结论：POEM治疗EA具有较好的中长期疗效和安全性，复发率低，有望成为EA的首选治疗方法。其远期疗效和并发症有待进一步随访观察。Background： Peroral endoscopic myotomy （POEM） is a novel minimally invasive endoscopic technique for treatment of esophageal achalasia （EA）. It has been demonstrated to be safe and effective in several short-term clinical studies, however, studies focusing on its mid- and long-term outcome are rare. Aims： To investigate the mid-and-long term efficacy of POEM in EA patients. Methods： A retrospective analysis was performed in 41 EA patients who underwent POEM in the Department of Gastroenterology and Hepatology of Nanjing General Hospital of Nanjing Military Region from Jul. 2012 to Dee. 2013. All these patients were followed up periodically for clinical symptoms （Eckardt score） , maximum esophageal diameter and lower esophageal sphincter pressure （LESP） , and the intra- and post-operative complications and recurrence were recorded. Results： POEM was successfully completed in all 41 EA patients, the mean operative time was （69.5 ＋ 20.6） min （range 35-125min）, and the mean length of hospital stay was 3.5 days. Compared with the pre-operative data, the post-operative Eckardt score, maximum esophageal diameter and LESP during follow-up （mean 26.3 months, range 19-36 months） were significantly decreased （P all 〈 0.05）. Procedure-related complications were seen in 6 patients （14.6%）; the clinical success rate was 95.1% （39/41） and the recurrence rate was 2.4% （1/41）. Conclusions： POEM is safe and effective in mid-and-long term follow-up with low recurrence rate. It might become the first-line therapy for EA, and the long-term efficacy and complications need further follow-up study.

关 键 词：食管失弛症 经口内镜下肌切开术 治疗结果 回顾性研究 

分 类 号：R655.4[医药卫生—外科学]