高分辨率食管测压评估经口内镜下肌切开术治疗儿童贲门失弛缓症的临床研究  

Evaluation of high resolution esophageal manometry in peroral endoscopic myotomy for pediatric achalasia of cardia

作　　者：张含花[1] 方莹[1] 任晓侠[1] 杨洪彬[1] 韩亚楠[1] 葛库库 刘昪华 王风范 周平红 Zhang Hanhua;Fang Ying;Ren Xiaoxia;Yang Hongbin;Han Yanan;Ge Kuku;Liu Bianhua;Wang Fengfan;Zhou Pinghong(Department of Gastroenterology,Xi′an Children′s Hospital,Xi′an 710003,China;Endoscopy Center and Endoscopy Research Institute,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]西安市儿童医院消化内科,710003 [2]复旦大学附属中山医院内镜中心,上海200032

出　　处：《中华消化内镜杂志》2021年第1期57-61,共5页Chinese Journal of Digestive Endoscopy

基　　金：西安市科学技术局科技行动计划(20YXYJ0002);西安市卫生和计划生育委员会卫生科研人才培训项目(J201703051)。

摘　　要：目的探讨高分辨率食管测压(high resolution esophageal manometry,HREM)评估贲门失弛缓症(achalasia of cardia,AC)儿童经口内镜下肌切开术(peroral endoscopic myotomy,POEM)效果的作用。方法收集2013年1月—2019年9月于西安市儿童医院行POEM治疗的30例AC患儿资料。患儿分别于POEM治疗前及治疗后6个月行HREM。比较术前与术后患儿食管下括约肌静息压(lower esophageal sphincter pressure,LESP)、4 s完整松弛压(4-second integrated relaxation pressure,4sIRP)、Eckardt症状评分及营养状况。结果行POEM治疗的AC患儿年龄4~14岁。LESP术后为(5.50±1.13)mmHg(1 mmHg=0.133 kPa),较术前的(26.23±4.47)mmHg明显降低,差异有统计学意义(t=-24.623,P<0.001);术后中位4sIRP为5 mmHg,较术前的25 mmHg降低20 mmHg,差异有统计学意义(Z=-4.786,P<0.001)。术后中位Eckardt症状评分为1分,较术前的8分显著下降,差异有统计学意义(Z=-4.796,P<0.001);患儿的营养状况由术前的重度营养不良明显改善至正常(Z=-5.166,P<0.001)。结论POEM治疗能显著改善AC患儿的食管动力学特征,HREM可作为AC患儿POEM术后随访评估的重要客观指标。Objective To evaluate high resolution esophageal manometry(HREM)in peroral endoscopic myotomy(POEM)for pediatric achalasia of cardia(AC).Methods Data of 30 AC children who received POEM in Xi′an Children′s Hospital from January 2013 to September 2019 were reviewed.HREM was performed before and 6 months after POEM.Preoperative and postoperative lower esophageal sphincter pressure(LESP),4-second integrated relaxation pressure(4sIRP),Eckardt scores and nutritional status were compared.Results Children with AC aged between 4-14 years.Postoperative LESP was 5.50±1.13 mmHg(1 mmHg=0.133 kPa),which was significantly lower than that before operation(26.23±4.47 mmHg)with significant difference(t=-24.623,P<0.001).Postoperative median 4sIRP was 5 mmHg,which was 20 mmHg lower than that before operation(25 mmHg)with significant difference(Z=-4.786,P<0.001).Postoperative median Eckardt symptom score decreased significantly compared with that before(1 VS 8,Z=-4.796,P<0.001).Severe malnutrition of the AC children improved evidently to normal(Z=-5.166,P<0.001).Conclusion POEM can significantly improve the characteristics of esophageal dynamics in children with AC,and HREM can be an important indicator for follow-up evaluation of POEM.

关 键 词：儿童 食管失弛症 贲门 经口内镜下肌切开 高分辨率食管测压 

分 类 号：R726.5[医药卫生—儿科]