全球首例经口内镜肌切开术治疗贲门失弛缓症合并先天性成骨不全的临床实践  

Peroral endoscopic myotomy for achalasia of cardia complicated with congenital osteogenesis imperfecta:the first clinical practice in the worldwide

作　　者：诸炎 李全林 蔡明琰 胡健卫 钟芸诗 蔡世伦 陈巍峰 张轶群 周平红 ZHU Yan;LI Quan-lin;CAI Ming-yan;HU Jian-wei;ZHONG Yun-shi;CAI Shi-lun;CHEN Wei-feng;ZHANG Yi-qun;ZHOU Ping-hong(Endoscopy Center,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院内镜中心,复旦大学内镜诊疗研究所,上海200032

出　　处：《中国临床医学》2018年第2期178-181,共4页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(81301760,81470811,81670483);上海市科委重大项目(16411950400)

摘　　要：目的:总结全球首例经口内镜肌切开术(POEM)治疗贲门失弛缓症合并先天性成骨不全患者的临床实践经验。方法:患者男性,21岁,术前Eckardt评分7分,确诊贲门失弛缓症伴先天性成骨不全。完善相关术前检查后于全麻下实施POEM术:首先距离门齿28cm作黏膜切口,胃镜进入黏膜下层并分离至贲门下3cm,随后距门齿29cm至贲门下2cm将环状肌束切断,观察贲门口松弛后电凝止血并使用钛夹关闭黏膜下隧道口。结果:手术顺利完成,总用时28min,术后30h拔除胃管并饮用清水。患者于术后第4天出院,出院时无不适主诉。术后2周随访Eckardt评分为0分。结论:POEM治疗贲门失弛缓症合并先天性成骨不全安全、有效。Objective:To solve the symptoms of achalasia complicated with osteogensis imperfecta through peroral endoscopic myotomy(POEM).Methods:The 21-year-old male patient,being diagnosed as achalasia complicated with osteogensis imperfecta,underwent POEM under general anesthesia after preoperative assessment of achalasia(Eckardt score of 7).The mucosal incision was made at a distance of 28 cm from the incisor,then the gastroscope entered the submucosal layer and tunnel in it,and myotomy was performed about 29 cm from the incisor extending 2 cm into the cardia.Electrocoagulation was performed to stop bleeding and the mucosal incision was then closed.Results:The operation was completed successfully in about 28 minutes.The stomach tube was removed 30 h after surgery.The patient was discharged in a stable condition on the fourth postoperative day.The follow-up result showed no recurrence in symptom with Eckardt score of 0 two weeks after operation.Conclusions:POEM is a feasible and effective way for achalasia of cardia complicated with osteogenesis imperfecta.

关 键 词：经口内镜肌切开术 贲门失弛缓症 先天性成骨不全 

分 类 号：R655[医药卫生—外科学]