腹腔镜Heller肌切开术与经口内镜下肌切开术治疗贲门失弛缓症疗效及安全性的meta分析  

Efficacy and safety of laparoscopic Heller myotomy versus peroral endoscopic myotomy on esophageal achalasia:A meta-analysis

作　　者：叶智博 李可勇 阙昌浩 王亚平 苟云久[2] Ye Zhibo;Li Keyong;Que Changhao;Wang Yaping;Gou Yunjiu(First School of Clinical Medical,Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of Thoracic Surgery,Gansu Provincial Hospital,Lanzhou 730000,China)

机构地区：[1]甘肃中医药大学第一临床医学院,甘肃兰州730000 [2]甘肃省人民医院胸外科,甘肃兰州730000

出　　处：《临床荟萃》2024年第8期684-692,共9页Clinical Focus

基　　金：临床医学研究中心建设甘肃省胸部疾病临床医学研究中心(21JR7RA673);甘肃省青年科技基金miR-125a-5p靶向调控RNF168影响食管癌转移的机制研究(22JR11RA241)。

摘　　要：目的系统评价腹腔镜Heller肌切开术(LHM)与经口内镜下肌切开术(POEM)治疗贲门失弛缓症的疗效及安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science及万方数据库、维普数据库、中国知网数据库(CNKI),搜索建库至2023年11月公开发表的相关文献,采用RevMan 5.0软件进行meta分析。结果共纳入15篇文献,其中1篇是随机对照试验,8篇是回顾性队列研究,6篇是前瞻性非随机对照试验。共1439例患者,LHM组696例,POEM组743例。Meta分析结果显示,与LHM组相比,POEM组术后吞咽困难复发率更低[OR=2.01,95%CI(1.17,3.44),P=0.01]、手术时间更短[MD=22.66,95%CI(5.57,39.75),P=0.009]、住院时间更短[MD=0.55,95%CI(0.38,0.71),P<0.01]、术后恢复正常生活天数更少[MD=4.49,95%CI(4.00,4.97),P<0.01],在胃食管反流病发生率和术后皮下气肿发生率上LHM低于POEM[OR=0.64,95%CI(0.45,0.90),P=0.009;OR=0.33,95%CI(0.11,0.99),P=0.05];而在术后总并发症发生率、术后质子泵抑制剂使用率、术后6个月Eckardt评分等方面,两个术式差异无统计学意义(P>0.05)。结论与LHM相比,POEM术后吞咽困难复发率、手术时间、住院时间、术后恢复正常生活天数更具优势。Objective To systematically evaluate the efficacy and safety of laparoscopic Heller myotomy(LHM)versus peroral endoscopic myotomy(POEM)on esophageal achalasia.Methods Relevant articles reporting the efficacy and safety of LHM versus POEM on esophageal achalasia published up to November 2023 were searched in the PubMed,EMbase,The Cochrane Library,Web of Science,Wanfang database,VIP and China Knowledge Network database(CNKI).Meta-analysis was performed using RevMan 5.0 software.Results A total of 15 articles were included,including 1 randomized controlled trial,8 retrospective cohort studies,and 6 prospective non-randomized controlled trials.A total of 1,439 patients were included,with 696 patients in the LHM group and 743 in the POEM group.Meta-analysis showed that POEM resulted in a significantly lower recurrent rate of postoperative dysphagia(OR=2.01,95%CI 1.17,3.44,P=0.01),shorter operative time(MD=22.66,95%CI 5.57,39.75,P=0.009),shorter length of stay(MD=0.55,95%CI 0.38,0.71,P<0.01),fewer days to return to normal life after surgery(MD=4.49,95%CI 4.00,4.97,P<0.01)than those in the LHM group,LHM resulted in a significantly lower incidences of gastroesophageal reflux disease(OR=0.64,95%CI 0.45,0.90,P=0.009)and postoperative subcutaneous emphysema(OR=0.33,95%CI 0.11,0.99,P=0.05)than those in the POEM group.The incidence of total postoperative complications,postoperative proton pump inhibitors utilization,and postoperative Eckardt score at 6 months were comparable between groups(P>0.05).Conclusion Compared with LHM,POEM has more advantages in lowering the recurrence of postoperative dysphagia,operative time,length of stay,and duration to return to normal life after surgery.

关 键 词：贲门失弛缓症 腹腔镜Heller肌切开术 经口内镜下肌切开术 META分析 

分 类 号：R571[医药卫生—消化系统]