经口内镜下憩室嵴和肌切开术治疗膈上食管憩室合并胃食管连接部流出道障碍临床分析  

Clinical analysis of peroral endoscopic diverticulotomy for the treatment of esophageal epiphrenic diverticulum with esophagogastric junction outflow tract disorder

作　　者：吴传楠 李璇 司新敏[2] 张伟锋[2] 焦春花[2] 唐娜娜[2] 叶必星[2] 王美峰[2] 张国新[2] 王云[2] Wu Chuannan;Li Xuan;Si Xinmin;Zhang Weifeng;Jiao Chunhua;Tang Nana;Ye Bixing;Wang Meifeng;Zhang Guoxin;Wang Yun(Department of Gastroenterology,the Municipal Hospital Affiliated to Xuzhou Medical University,Xuzhou221000,China;Department of Gastroenterology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]徐州医科大学附属徐州市立医院消化内科,徐州221000 [2]南京医科大学第一附属医院消化内科,南京210029

出　　处：《中华消化杂志》2022年第6期366-371,共6页Chinese Journal of Digestion

基　　金：国家自然科学基金面上项目(81970499);江苏省重点研发计划(BE2020784);徐州市临床技术骨干研修计划(2020GG008)。

摘　　要：目的评价内镜经黏膜下隧道憩室嵴离断术(STESD)联合经口内镜下肌切开术(POEM)治疗膈上食管憩室合并胃食管连接部(EGJ)流出道障碍的安全性和有效性。方法纳入于2017年10月至2021年8月在南京医科大学第一附属医院内镜中心行STESD联合POEM的膈上食管憩室合并EGJ流出道障碍的6例患者,回顾性分析患者的临床特征,包括男女比,年龄,病程,憩室长径、部位、是否多发,EGJ流出道障碍疾病类型,是否达到内镜技术成功(内镜下所有步骤均完成,包括建立隧道,切开憩室嵴、食管下括约肌、贲门固有肌),手术时间,手术前后临床症状(包括体重减轻、吞咽困难、胸骨后疼痛和反流)的严重程度(采用Eckardt评分进行评估)变化,术中和术后并发症的发生情况,以及随访情况,包括是否达到临床成功(吞咽困难、进食后呕吐、胸骨后疼痛、反流、体重减轻症状完全改善或近乎完全改善,随访时无需重复内镜干预)和有无不良事件发生。采用描述性方法进行统计学分析。结果6例患者的男女比为3∶3,中位年龄为69.2岁,中位病程为92.3个月;中位憩室长径为47.5 mm;憩室位于食管右侧壁4例,位于食管左侧壁2例,其中1例患者为食管多发憩室;贲门失弛缓症5例,EGJ出口梗阻1例。6例患者均顺利完成STESD联合POEM,并均达到内镜技术成功;手术时间(范围)为55 min(40~70 min)。术前和术后临床症状的Eckardt评分(范围)分别为9.0分(7.0~11.0分)、1.3分(1.0~2.0分),术后临床症状较术前改善;术后无迟发性出血、穿孔、感染、皮下气肿等并发症和严重不良事件发生。6例患者均痊愈出院,随访1~50个月,患者吞咽困难、进食后呕吐、胸骨后疼痛、反流、体重减轻症状均较术前明显改善,均无严重不良事件发生,均达到临床成功。结论STESD联合POEM治疗膈上食管憩室合并EGJ流出道障碍安全、有效,且近期和远期效果较好。Objective To evaluate the safety and efficacy of combination of submucosal tunneling endoscopic septum division(STESD)and peroral endoscopic myotomy(POEM)for the treatment of esophageal epiphrenic diverticulum with esophagogastric junction(EGJ)outflow tract disorder.Methods From October 2017 to August 2021,6 patients with esophageal epiphrenic diverticulum complicated with EGJ outflow tract disorder receiving combination of STESD and POEM in the Endoscopic Center of the First Affiliated Hospital of Nanjing Medical University were enrolled.The clinical characteristics of the patients were retrospectively analyzed,which included the ratio of male to female,age,course of disease,length of diverticula,location,whether with multiple diverticula,type of EGJ outflow tract disorders,whether the endoscopic technique was successful(the completion of all steps under endoscopy,including tunnel establishment and diverticulum cristae,lower esophageal sphincter and cardia muscularis propria incision);operation time,changes in the severity of clinical symptoms before and after operation(including weight loss,dysphagia,retrosternal pain,and reflux assessed using the Eckardt score),intraoperative and postoperative complications,and follow-up,including whether achieved clinical success(complete or nearly complete improvement of dysphagia,vomiting after eating,retrosternal pain,regurgitation,weight loss,no need for repeat endoscopic intervention during follow-up)and adverse events.Descriptive methods were used for statistical analysis.Results The male to female ratio of the 6 patients was 3 to 3,the median age was 69.2 years old,and the median disease course was 92.3 months.The median length of the diverticula was 47.5 mm.Diverticulum was located in the right wall of esophagus in 4 cases and in the left wall of esophagus in 2 cases,of which 1 patient was multiple diverticulum of esophagus.Achalasia was found in 5 cases,and EGJ outflow obstruction was found in 1 case.All the 6 patients successfully completed combination of STESD and

关 键 词：内镜经黏膜下隧道憩室嵴离断术 经口内镜下肌切开术 膈上食管憩室 胃食管连接部流出道障碍 

分 类 号：R655.4[医药卫生—外科学]