经口内镜下肌切开术联合部分食管下段肌层“V”型切除术治疗贲门失弛缓症的方法学、短期疗效及组织标本评估(含视频)  

Evaluation of methodology,short-term efficacy and tissue sample of peroral endoscopic myotomy combined with full thickness V-shaped resection of partial lower esophageal muscle for achalasia(with video)

作　　者：王涛[1] 王彬[1] 郑忠青[1] 陈鑫[1] 张莉莉[1] 晋弘[1] 吴兰兰[1] 赵威[1] 陈秋宇 王邦茂[1] Wang Tao;Wang Bin;Zheng Zhongqing;Chen Xin;Zhang Lili;Jin Hong;Wu Lanlan;Zhao Wei;Chen Qiuyu;Wang Bangmao(Department of Gastroenterology and Hepatology,Tianjin Medical University General Hospital,Tianjin Institute of Digestive Diseases,Tianjin Key Laboratory of Digestive Diseases,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院消化科天津市消化疾病研究所天津市消化病学重点实验室,300052

出　　处：《中华消化内镜杂志》2020年第12期868-873,共6页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金青年项目(81600425);天津市赵以成医学科学基金青年孵育项目(ZYYFY2018021)。

摘　　要：目的评估经口内镜下肌切开术(peroral endoscopic myotomy,POEM)联合部分食管下段肌层"V"型切除术治疗贲门失弛缓症(achalasia,AC)的短期疗效、安全性及建立食管下括约肌全肌层标本取材的方法。方法纳入2018年2月-2019年2月在天津医科大学总医院接受内镜治疗的AC患者,利用随机数字表将其按1∶3的比例随机分为POEM联合部分食管下段肌层"V"型切除术组和POEM组。评估2组患者手术时长、术中出血量和并发症发生情况;比较2组患者治疗后1个月和3个月Eckardt评分、反流症状评分、高分辨率食管测压和食管排空参数;比较2组术中获取组织标本的大小、质量和显微结构。结果本研究最终纳入57例患者,其中POEM联合部分食管下段肌层"V"型切除术组16例、POEM组41例。2组患者均成功完成手术,手术时长[(87.81±13.03)min比(82.20±18.10)min,t=1.302,P=0.201]和术中出血量[(6.75±1.44)mL比7.00(2.00)mL,U=-0.903,P=0.348]比较差异无统计学意义;术中和术后均未发生严重并发症。术后1个月和3个月时分别进行随访,2组患者Eckardt评分[0.00(1.00)分比0.00(1.00)分,U=-0.156,P=0.876;0.00(1.00)分比0.00(1.00)分,U=-0.337,P=0.736]、反流症状评分[0.00(0.00)分比0.00(0.00)分,U=-0.207,P=0.836;0.00(0.00)分比0.00(0.00)分,U=-0.207,P=0.836]、食管下括约肌压力[(16.00±7.00)mmHg比(13.76±6.21)mmHg,t=1.183,P=0.242;(15.06±4.14)mmHg比11.00(7.00) mmHg,U=-1.852,P=0.064](1 mmHg=0.133 kPa)、4 s完整松弛压[(6.57±2.69)mmHg比(6.82±2.22)mmHg,t=-0.364,P=0.717;(5.96±1.84)mmHg比(6.46±1.43)mmHg,t=-1.095,P=0.278]及食管排空检查5 min钡剂高度[(2.16±0.91) cm比(2.13±0.87) cm,t=0.127,P=0.899;(2.22±0.51) cm比(2.10±0.87) cm,t=0.657,P=0.514]等指标相比差异均无统计学意义,2组患者上述各指标均较术前明显降低(P均<0.05),且同组术后两次随访结果相比,上述各指标差异未见统计学意义(P均>0.05)。术后短期随访期间2组分别有1例和2例患者诉偶尔Objective To evaluate the short-term fficacy and safety of peroral endoscopic myotomy(POEM)combined with full thickness V-shaped resection of partial lower esophageal muscle in treatment of achalasia and to develop a method for obtaining full-thickness smooth muscle samples of lower esophageal sphincter.Methods Achalasia patients who underwent endoscopic surgery at Tianjin Medical University General Hospital from February 2018 to February 2019 were randomly divided into a group of POEM combined with full thickness V-shaped resection of partial lower esophageal muscle(group A)and POEM group(group B)according to the ratio of 1:3 by using random number table.Operation duration,intraoperative blood loss,and other complications were compared between the lwo groups.Eckardt score,reflux score,high-resolution esophageal manometry and esophageal emptying parameters were compared 1 and 3 months after treatment in both groups.Additionally,the size,weight and microstructure of smooth muscle samples obtained during the operations were also compared.Results A total of 57 patients were included in the study,16 in group A,and 41 in group B,and all underwent operations successfully.No significant differences were found in operation duration or intraoperative bleeding between the two groups[87.81±13.03 min VS 82.20±18.10 min,t=1.302,P=0.201;6.75±1.44 mL VS 7.00(2.00)mL,U=-0.903,P=0.348].No serious complications occurred during or after operation.Follow-ups were performed at 1 and 3 months after operation.Eckardt score[0.00(1.00)VS0.00(1.00),U=-0.156,P=0.876;0.00(1.00)VS0.00(1.00),U=-0.337,P=0.736],refux score[0.00(0.00)VS 0.00(0.00),U=-0.207,P=0.836;0.00(0.00)VS 0.00(0.00),U=-0.207,P=0.836],lower esophageal sphincter pressure[16.00±7.00 mmHg VS 13.76±6.21 mmHg,t=1.183,P=0.242;15.06±4.14 mmHg VS 11.00(7.00)mmHg,U=-1.852,P=0.064](1 mmHg=0.133 kPa),4 s integrated relaxation pressure(6.57±2.69 mmHg VS 6.82±2.22 mmHg,t=-0.364,P=0.717;5.96±1.84 mmHg VS 6.46±1.43 mmHg,t=-1.095,P=0.278)and the height of barium in 5 min in esopha

关 键 词：贲门 食管失弛症 食管括约肌 下段 经口内镜下肌切开术 "V"型切除术 短期疗效 

分 类 号：R655.4[医药卫生—外科学]