高分辨率食管测压在贲门失弛缓症经口内镜下肌切开术效果评价中的价值

Evaluation of high-resolution esophageal manometry in patients with peroral endoscopic myotomy

摘要:

目的 观察经口内镜下肌切开术（POEM）治疗贲门失弛缓症（AC）前后食管压力的变化，并 探讨食管高分辨率测压（HRM）在评价POEM 疗效中的价值。方法 收集2015 年8 月－ 2016 年11 月在 郑州大学第一附属医院确诊为AC 并接受POEM 治疗者38 例，分别在术前、术后1 周和术后1 个月，采用 食管HRM 检测食管上扩约肌静息压（UESP）、食管下括约肌静息压（LESP）和食管下括约肌4 秒完整松 弛压（4sIRP），评价疗效进行回顾性分析。结果 38 例AC 患者的POEM 均顺利完成。患者术后1 周、术 后1 个月的食管UESP 分别为（45.34±26.52）和（41.27±20.09）mmHg，与术前（49.58±26.47）mmHg 相 比差异无统计学意义（t 术后1 周/ 术前 =0.49，t 术后1 个月/ 术前 =1.09，均P >0.05）；术后1 周和术后1 个月的食管LESP、 4sIRP 与术前相比差异均具有统计学意义（LESP ：t 术后1 周/ 术前 =3.86，t 术后1 个月/ 术前 =4.86 ；4sIRP ：t 术后1 周/ 术前 =4.85， t 术后1 个月/ 术前 =7.14；均P <0.05）；术后1 周与术后1 个月相比，UESP、LESP、4sIRP 变化差异均无统计学意义（UESP： t 术后1 周/ 术后1 个月 =0.53，LESP ：t 术后1 周/ 术后1 个月 =1.86 ；4sIRP ：t 术后1 周/ 术后1 个月 =1.84，均P >0.05）。结论 POEM 后食 管LESP 明显降低，吞咽困难改善，食管HRM 对于评价AC 经POEM 术的疗效有临床意义。

Abstract:

Objective To observe the changes of esophageal pressure in patients with achalasia (AC) before and after peroral endoscopic myotomy (POEM), and to explore the value of high-resolution manometry (HRM) in evaluating the efficacy of POEM. Methods 38 cases were diagnosed as achalasia and treated with POEM from August 2015 to November 2016. Upper esophageal sphincter resting pressure (UESP), lower esophageal sphincter resting pressure (LESP), esophageal sphincter 4s integrated relaxation pressure (4sIRP) were detected by HRM before operation, at 1 week, 1 month after operation to evaluate the efficacy. Results A total of 38 patients with AC received POEM. At one week, one month after operation, the UESP were (45.34 ± 26.52) mmHg, (41.27 ± 20.09) mmHg, compared with that of before operation (49.58 ± 26.47) mmHg and the differences were not statistically significant. The differences in LESP, 4sIRP between before operation and at one week, one month after operation were statistically significant, P < 0.05. The differences in UESP, LESP and 4sIRP between 1 week and 1 month after operation were not statistically significant. Conclusion The pressure of lower esophageal sphincter was significantly reduced and the dysphagia was improved. HRM might play an important role in the assessment of AC received POEM.