经口内镜下肌切开术治疗44例贲门失弛缓症的疗效观察*

Observation on POEM in treatment of Achalasia (44 cases)*

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。方法??选取2012年6月-2016年5月浙江大学医学院附属第一医院确诊为AC并接受POEM治疗的44例患者，观察患者手术前后AC临床症状评分系统（Eckardt评分）及胸部CT、食管X线造影结果，评价手术疗效。结果??44例患者均成功完成POEM，黏膜下隧道切开长度（12.9±1.1）cm，肌切开长度（9.6±2.4）cm。术后44例患者经1～39个月随访，术后Eckardt评分（1.1±1.1）分，较术前（6.6±2.0）分明显降低（P <0.01）。术前、术后行胸部CT 10例，术后食管最大径均值（25.7±8.5） mm，较术前（41.5±14.9） mm明显减小（P <0.01）。术前、术后行X线食管造影10例，术后食管最大径较术前缩小（29.3±16.8）%。44例患者体重由术前的（53.2±10.9）kg增加至术后的（58.3±11.7）kg，差异有统计学意义（P <0.01）。结论??POEM作为治疗AC的一种新兴的微创手术，其短中期疗效确切，可以有效缓解患者吞咽困难等症状，改善患者的营养状况。

Abstract:

Objective?To explore the clinical effect of POEM in treatment of Achalasia (AC).?Methods?From June, 2012 to May 2016, 44 patients confirmed as AC received POEM intervention. Then compare the Eckardt Gradings before and after the operation as well as the results of CT on the chest and esophageal barium imaging, then evaluate the effect of operation.?Results?44 patients successfully received POEM. Their submucosal tunnel incision length is (12.9 ± 1.1) cm, myotomy length is (9.6 ± 2.4) cm. Random sample visit for 1～39 months shows Eckardt Gradings reaches (1.1 ± 1.1) after operation, obviously reduced (P < 0.01) compared with (6.6 ± 2.0) before operation. 10 cases of CT on the chest before and after operation have esophageal maximum average diameter (25.7 ± 8.5) mm after operation, distinctly decreased compared with (41.5 ± 14.9) mm before operation (P < 0.01). 10 cases of X-ray esophageal imaging before and after operation indicate that esophageal maximum diameter narrows down by (29.3 ± 16.8) % than before. Body weight increases to (58.3 ± 11.7) kg after operation compared to (53.2 ± 10.9) kg before operation, which has the significance in statistics (P < 0.01).?Conclusions?As a booming minimally invasive surgery to treat Achalasia, POEM possesses specific curative effect in short and medium term, effectively relieved the sufferings like dysphagia and improving patients’ nutritional status.