经口内镜下肌切开术治疗贲门失弛症的临床疗效分析  

The clinical efficacy analysis of per-oral endoscopic myotomy for achalasia

作　　者：周煜燊 何利平[1] ZHOU Yu-shen;HE Li-ping(Department of Gastroenterology,Fujian Provincial Hospital South Branch,Fuzhou 350028,China)

机构地区：[1]福建省立医院南院消化内镜中心,福州350028

出　　处：《创伤与急诊电子杂志》2018年第2期81-86,共6页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨经口内镜下肌切开术治疗贲门失弛症的临床疗效。方法回顾性分析本院2010年8月至2017年12月确诊为贲门失弛症并于本科室行经口内镜下肌切开术(per-oral endoscopic myotomy, POEM)手术的48例患者的临床资料,根据有无既往诊疗史将患者分为2组,无既往诊疗史组34例,有既往诊疗史组14例,分析2组患者术后以及随访过程中并发症发生情况及临床疗效。结果 48例患者POEM手术均顺利完成。肌切开长度4～11 cm,随访时间3～88个月,术前Eckardt评分3～11分,平均(7.54±1.76)分,术后Eckardt评分0～5分,平均(1.67±1.31)分,较术前明显降低(P<0.05),3个月后4例Eckardt评分>3分,其中1例行第二次POEM手术,随访至目前(61个月)Eckardt评分<3分。术后并发症发生率20.8%(10/48),无一例与手术相关死亡病例,所有并发症经对症、保守治疗后痊愈,无一例追加外科手术。2组患者在并发症的发生率以及疗效上的差异无统计学意义。结论 POEM手术并发症的发生以及疗效与既往诊疗史无关,是一种治疗贲门失弛症安全、有效的手术方式,且有较好的远期疗效。Objective To evaluate the clinical efficacy of per-oral endoscopic myotomy （POEM） for achalasia Methods The clinical data of 48 cases of achalasia undergoing POEM from August 2010 to December 2017 at our center were retrospectively analyzed. Patients were divided into two groups according to the medical history, involving 34 patients without medical history and 14 patients with medical history. Complications during and after POEM and during follow-up and the efficacy of POEM in the two groups were analyzed. Results All the 48 patients underwent POEM successfully. The operation time ranged from 33 min to 163 min, and the length of endoscopic myotomy of inner circular muscle ranged from 4cm to 11cm. The patients were followed up for 3~88 months. The Eckardt Score before the operation was 3~11 points（mean 7.54±1.76）, the Eckardt Score after the operation was 0~5 points（mean1.67±1.31） , which was lower than that before significantly （P〈0.05）. The Eckardt Score of 4 cases was greater than 3 points after 3 months of the operation, and one of them underwent the second operation（POEM）, which has been followed up for 61 months and the Eckardt Score was less than 3 points. The post-operative incidence of complications was 20.8% （10/48）, and no POEM-correlated death was reported. All the complications were cured by conservative treatments without additional surgery. There was no significant difference in the incidence of complications and efficacy between the two groups. Conclusion The occurrence of complications and efficacy after receiving POEM are independent of medical history. POEM is a safe and effective treatment for achalasia, and it has a preferable long-term efficacy.

关 键 词：贲门失弛症 经口内镜下肌切开术 疗效 并发症 

分 类 号：R571[医药卫生—消化系统]