贲门失弛缓症经口内镜下肌切开术后食管动力类型分析  

Analysis of Esophageal Motility Patterns in Achalasia Patients After Peroral Endoscopic Myotomy

作　　者：陈棒 刘曼 徐红[1] 王丹[1] CHEN Bang;LIU Man;XU Hong;WANG Dan(Department of Gastroenterology,the First Hospital of Jilin University,Changchun,130021)

机构地区：[1]吉林大学第一医院胃肠内科,130021

出　　处：《胃肠病学》2022年第8期449-455,共7页Chinese Journal of Gastroenterology

摘　　要：背景:经口内镜下肌切开术(POEM)可能会使贲门失弛缓症患者的食管体部蠕动部分恢复,但其预测因素和临床相关性尚不清楚。目的:评估贲门失弛缓症患者POEM术后的食管动力类型变化,分析蠕动恢复可能的预测因素及其临床相关性。方法:回顾性纳入2012年3月-2021年3月于吉林大学第一医院诊断为贲门失弛缓症并首次行POEM治疗的患者,根据高分辨率食管测压(HREM)食管动力障碍芝加哥分类v4.0重新分析评估测压结果。结果:共81例贲门失弛缓症患者纳入研究,其中男性28例,女性53例,平均年龄(44.70±14.94)岁。POEM术前芝加哥分型:Ⅰ型31例,Ⅱ型46例,Ⅲ型4例。术后71.6%的患者整合松弛压(IRP)恢复正常(<15 mm Hg),32.1%的患者出现一定程度的基于食管测压标准的“蠕动恢复”,Ⅰ、Ⅱ、Ⅲ型患者蠕动恢复发生率依次增高(16.1%、39.1%和75.0%)。蠕动恢复组术前IRP、下食管括约肌静息压(LESP)显著高于无蠕动恢复组(P均<0.05)。Logistic回归分析显示,年龄、IRP、LESP、Eckardt评分和肌切开长度与蠕动恢复之间均无相关性(P均>0.05)。不同亚型患者术前Eckardt评分和术后改善程度无明显差异(P均>0.05);蠕动恢复与无恢复组间术后Eckardt评分改善程度亦无明显差异(P>0.05)。结论:POEM术后部分贲门失弛缓症患者出现基于食管测压标准的“蠕动部分恢复”,Ⅲ型和Ⅱ型患者更易出现此现象,但未发现此现象存在预测因素和临床相关性。The peristalsis of esophageal body in patients with achalasia may be partially recovered after peroral endoscopic myotomy(POEM),but its predicting factors and clinical relevance remain unclear.Aims:To evaluate the change of esophageal motility patterns in achalasia patients after POEM,and to analyze the possible predictors of peristalsis recovery and its clinical relevance.Methods:A retrospective study was performed on patients diagnosed with achalasia and receiving the first POEM treatment from March 2012 to March 2021 at the First Hospital of Jilin University.According to the Chicago Classification v4.0(CCv4.0)for esophageal motility disorders on high⁃resolution esophageal manometry(HREM),the esophageal motility pattern was re⁃assessed and analyzed.Results:Eighty⁃one achalasia patients were enrolled in the study,including 28 males and 53 females,with a mean age of(44.70±14.94)years old.Based on CCv4.0,these patients were divided into three subtypes before POEM,including 31 typeⅠ,46 typeⅡ,and 4 typeⅢachalasia.After POEM,the integrated relaxation pressure(IRP)of 58(71.6%)patients returned to normal(<15 mm Hg),and to some extent‘peristalsis recovery’based on manometry was observed in 26 patients(32.1%).The incidence of peristalsis recovery of typeⅠ,typeⅡand typeⅢachalasia patients were increased gradually(16.1%,39.1%and 75.0%).In peristalsis recovery group,the pre⁃POEM IRP and lower esophageal sphincter resting pressure(LESP)were significantly higher than those in non⁃peristalsis recovery group(all P<0.05).Logistic regression analysis showed that no correlations were existed between age,IRP,LESP,Eckardt score,length of myotomy and peristalsis recovery(all P>0.05).There were no significant differences in Eckardt score before POEM and its improvements after POEM among different subtypes of achalasia(all P>0.05).Furthermore,no significant difference was observed in improvement in Eckardt score between peristalsis recovery and non⁃peristalsis recovery groups after POEM(P>0.05).Conclusions:

关 键 词：贲门失弛缓症 经口内镜下肌切开术 食管动力障碍 高分辨率食管测压 

分 类 号：R655.4[医药卫生—外科学]