经口内镜下肌切开术治疗贲门失弛缓症临床疗效和并发症的分析

Clinical efficacy and complications of transoral endoscopic peroral endoscopic myotomy for achalasia

摘要:

目的 探讨经口内镜下肌切开术（POEM）治疗贲门失弛缓症（AC）的临床疗效和并发症。方法 对2013年1月-2015年1月该院消化内镜中心的38例AC患者进行POEM治疗，观察手术相关并发症和胃食管反流情况，并对比分析治疗前后贲门失弛缓症临床症状评分系统（ECKARDT）评分和食管下段括约肌（LES）压力变化。结果 38例均成功实施POEM手术，无1例出现与POEM相关的严重并发症，出血、气体相关并发症均保守治疗成功。术后随访时间10.4个月（9～12个月），所有患者症状缓解，ECKARDT评分平均分从术前的8.7分降至术后的1.2分（P <0.01），食管括约肌压力明显降低，平均压从术前的（33.40±11.80）mmHg下降至术后的（13.50±4.30）mmHg（P <0.01），气体相关并发症6例（15.78%），食管反流总发生率为23.68%（9/38）。结论 POEM用于AC的治疗是安全、有效的，并且具有较好的远期疗效。

Abstract:

Objective To explore the clinical efficacy and complications of transoral endoscopic peroral endoscopic myotomy (POEM) for achalasia (AC). Methods 38 patients with AC received POEM treatment from January 2013 to January 2013 in our digestive endoscopy center. Procedure-related complications and gastroesophageal reflux were observed, and ECKARDT score and the lower esophageal sphincter pressure changes were analysed. Results All patients underwent POEM successfully. No serious POEM-related complications were observed, bleeding, gas related complications were treated successfully by conservative treatment. Postoperative follow-up time was 10.4 months (range 9 to 12 months), the symptoms of all the patients were alleviated, ECKARDT score average from preoperative 8.7 points dropped to postoperative 1.2 points (P < 0.01), esophageal sphincter pressure decreased significantly, mean pressure dropped from preoperative (33.40 ± 11.80) mmHg to postoperative (13.50 ± 4.30) mmHg (P < 0.01) and gas related complications occurred in 6 cases (15.78 %), esophageal reflux occurred rate total was 23.68 % (9/38). Conclusion POEM is safe and effective for the treatment of AC, and has better long-term effect.