经口内镜下肌切开术治疗贲门失弛缓症的临床效果  

Clinical effects of peroral endoscopic myotomy in treatment of achalasia

作　　者：苏荣芝 陈艳敏 Rong-Zhi Su;Yan-Min Chen(Faculty of Medicine,Kunming University of Science and Technology,Kunming 650033,Yunnan Province,China;Department of Gastroenterology,Yunnan First People’s Hospital,Kunming 650034,Yunnan Province,China)

机构地区：[1]昆明理工大学医学院,云南省昆明市650033 [2]云南省第一人民医院消化内科,云南省昆明市650034

出　　处：《世界华人消化杂志》2022年第24期1066-1073,共8页World Chinese Journal of Digestology

摘　　要：背景经口内镜下肌切开术(peroral endoscopy myotomy,POEM)是治疗贲门失弛缓症(achalasia of cardia,AC)的一种安全有效的方法,短期内能显著改善患者临床症状,但其远期疗效研究较少,通过对比分析AC患者行POEM治疗前后临床症状评分、内镜和食管动力改变,评价POEM治疗AC的临床效果,可为临床工作提供一定的诊断价值.目的观察分析POEM治疗AC的临床效果.方法采集云南省第一人民医院消化内科2013-07/2019-01诊断为AC并行POEM治疗的28例患者资料,对比分析AC治疗前后临床症状评分、内镜和食管动力改变,评价POEM治疗AC的临床效果.结果在28例患者中,病程2mo-360mo,手术成功率为100.0%,随访时间为1mo-36mo,POEM术治疗前后Eckardt评分有统计学差异(P<0.001),Ⅰ、Ⅱ型AC患者的Eckardt总分均较术前明显下降(P均<0.05);术后随访复查胃镜,通过贲门无明显阻力,食道扩张改善,腔内未见大量食物潴留.食管下括约肌静息压(resting pressure of lower esophageal sphincter,LESP),食管下括约肌完整松弛压(integrated relaxation pressure,IRP),术后较术前明显降低,总体及Ⅱ型差异有统计学意义(P<0.05),Ⅰ型差异无统计学意义.术后食管上括约肌静息压(resting pressure of the upper esophageal sphincter,UESP)及食管下括约肌长度(lower esophageal sphincter length,LESL)较术前,总体及分型差异无统计学意义.结论POEM为治疗AC的有效手段,短期疗效确切,且安全性相对较高,部分食管动力学指标较前改善,但其远期并发症及有效性还需大样本进一步随访.BACKGROUND Peroral endoscopic myotomy(POEM)is a safe and effective method for the treatment of achalasia of cardia(AC),which can significantly improve the clinical symptoms in a short term.However,there are few studies on its long-term efficacy.AIM To observe and analyze the clinical effects of POEM in the treatment of AC.METHODS The data of 28 patients diagnosed with AC and treated by POEM at the Department of Gastroenterology,Yunnan First People’s Hospital from July 2013 to January 2019 were collected.The clinical symptom score and endoscopic and esophageal motility changes of the patients before and after POEM were analyzed to evaluate the clinical efficacy of POEM in the treatment of AC.RESULTS Among the 28 patients included,the duration of disease ranged from 2 to 360 mo,the success rate of surgery was 100.0%,and the follow-up time ranged from 1 to 36 mo.There was a significant difference in Eckardt score before and after POEM(P<0.001).The total Eckardt scores in patients with types I and II AC after POEM were significantly lower than those before operation(P<0.05).Postoperative follow-up gastroscopy showed no significant resistance through the cardia,improved esophageal dilatation,and no large amount of food retention in the lumen.The resting lower esophageal sphincter pressure and integrated relaxation pressure of the lower esophageal sphincter after operation were significantly lower than those before operation,and the differences in overall and type II patients were statistically significant(P<0.05),while the differences in type I patients were not statistically significant.There was no significant difference in resting upper esophageal sphincter pressure or lower esophageal sphincter length after operation compared with before operation.CONCLUSION POEM is an effective treatment for AC,with definite short-term efficacy and relatively high safety.Some esophageal motility indexes are improved,but its long-term complications and effectiveness need further follow-up with large samples.

关 键 词：经口内镜下肌切开术 贲门失弛缓症 疗效 

分 类 号：R656.61[医药卫生—外科学]