高分辨率食管测压对食管平滑肌瘤EMR/ESD术的疗效评估  

Evaluation of the efficacy of high-resolution esophageal manometry in EMR/ESD surgery for esophageal leiomyoommaa

作　　者：张静智[1] 曾玲[1] 刘雪[1] 石柳[1] 温建军[1] Zhang Jingzhi;Zeng Ling;Liu Xue;Shi Liu;Wen Jianjun(Ganzhou People's Hospital,341000,Ganzhou,Jiangxi)

机构地区：[1]江西省赣州市人民医院,江西赣州341000

出　　处：《辽宁医学杂志》2024年第6期35-38,共4页Medical Journal of Liaoning

基　　金：赣州市指导性科技计划项目,GZ2022ZSF049。

摘　　要：目的 探讨使用高分辨率食管测压(HRM)对食管平滑肌瘤内镜下黏膜病损切除术(EMR)和内镜下黏膜病损剥离术(ESD)术后的疗效。方法 选取2021年4月至2022年10月我院食管平滑肌瘤患者30例,在EMR/ESD术前、术后1月和术后6月均进行反流症状评估和内镜检查,对比食管高分辨率测压结果(食管下括约肌静息压、食管下括约肌松弛率、食管下端压力等)、食道体部收缩最大波幅(AP)及体部蠕动波传导速度,术后创面愈合情况,评估EMR/ESD术治疗效果。结果 术后采用胃镜随访时间1~6个月,随访期创面愈合情况好,未见肿瘤残留或复发病例,无食管狭窄,吞咽不畅,胸部不适等症状。术前食管下括约肌静息压(LESP)、食管下括约肌松弛率(LESRR)、食管下段压力、蠕动收缩百分比分别为(8.50±5.30)mmHg(1mmHg=0.133kPa)、(27.4±18.4)%、(36.76±17.33)mmHg、(10.54±2.15)%,分别低于术后6个月(16.40±3.53)mmHg、(58.1±17.9)%、(56.83±21.72)mmHg、(8.62±2.35)%,差异均有统计学意义(P<0.05)。反流评分显著降低(P<0.05),AP和体部蠕动波传导速度明显升高(P<0.05)。结论 实验结果对比术前患者的症状明显改善,EMR/ESD术治疗有效,内镜下愈合情况良好,测压结果有效升高,证明使用高分辨率食管测压对食管EMR/ESD术后进行评估有效可行。Objective To explore the efficacy of high-resolution esophageal manometry(HRM)in the treatment of e-sophageal leiomyoma after endoscopic mucosal lesion resection(EMR)and endoscopic mucosal lesion dissection(ESD).Methods From April 2021 to October 2022,30 patients with esophageal leiomyoma in our hospital were selected for reflux symptom assessment and endoscopic examination before,one month after and six months after EMR/ESD.The results of e-sophageal high-resolution pressure measurement(resting pressure of lower Sphincter,relaxation rate of lower Sphincter,lower esophageal pressure,etc.),maximum amplitude of esophageal body contraction(AP),body peristaltic wave conduction ve-locity,and wound healing after operation were compared,Evaluate the therapeutic effect of EMR/ESD surgery.Results The patients were followed up with gastroscope for 1~6 months.During the follow-up period,the wound healed well,no re-sidual tumor or recurrence cases were found,no Esophageal stricture,dysphagia,chest discomfort and other symptoms were found.The preoperative resting pressure(LESP)of lower esophageal Sphincter,the relaxation rate of lower esophageal Sphincter(LESRR),the pressure of lower esophageal segment,and the percentage of peristaltic contraction were(8.50±5.30)mmHg(1mmHg=0.133kPa),(27.4±18.4)%,(36.76±17.33)mmHg,(10.54±2.15)%,respectively,which were lower than those of(16.40±3.53)mmHg,(58.1±17.9)%,(56.83±21.72)mmHg,and(8.62±2.35)%6 months after surgery(P<0.05).The reflux score significantly decreased(P<0.05),while AP and body peristaltic wave conduction velocity significantly increased(P<0.05).Conclusion Compared with preoperative patients,the experimental results showed a significant improvement in symptoms.EMR/ESD surgery was effective,with good healing under endoscopy and an effective increase in pressure measurement results.This proves that using high-resolution esophageal pressure meas-urement for postoperative evaluation of esophageal EMR/ESD is effective and feasible.

关 键 词：高分辨率食管测压 食管平滑肌瘤 内镜下黏膜下病损剥离术 内镜下黏膜病损切除术 

分 类 号：R735.1[医药卫生—肿瘤]