高分辨率食管测压在经口内镜下肌切开术治疗贲门失弛缓症中的应用价值

Clinical value of high-resolution manometry in peroral endoscopic myotomy with achalasia

摘要:

目的 对贲门失弛缓症（AC）患者实施经口内镜下肌切开术（POEM），在术前术后行高分辨率食管测压（HRM），评估POEM手术的疗效，进一步探讨HRM在POEM治疗AC中的临床应用价值。方法 纳入2018年1月－2019年12月就诊于青岛大学附属烟台毓璜顶医院消化内科确诊为AC并行POEM术的患者26例，记录术前Eckardt评分、食管测压的食管上括约肌静息压（UESP）、食管下括约肌静息压（LESP）、4s完整松弛压力（4sIRP）、食管下括约肌长度（LESL）和随访6个月时的Eckardt评分，分析术前术后评分和测压数据是否具有明显差异及相关性。结果 26例患者术前和术后随访6个月的Eckardt评分分别为（6.50±1.30）和（1.04±0.53）分，术后较术前评分明显下降，差异有统计学意义（P < 0.05）。POEM术前术后UESP为（50.15±16.74）和（44.70±11.71）mmHg，差异无统计学意义（P > 0.05），术前术后LESP为（30.92±10.49）和（17.40±6.14）mmHg，差异有统计学意义（P < 0.05），术前术后4sIRP为（22.16±7.75）和（9.45±4.23）mmHg，差异有统计学意义（P < 0.05），术前术后LESL为（3.38±0.65）和（3.34±0.72）cm，差异无统计学意义（P > 0.05）。4sIRP和Eckardt评分具有相关性（r = 0.55，P < 0.05）。Ⅱ型AC患者4sIRP平均降低率更高（62.20%）。结论 POEM治疗AC安全、有效，4sIRP可以评价治疗效果，Ⅱ型AC患者对POEM治疗反应较好。

Abstract:

Objective To evaluate the efficacy of POEM by high-resolution manometry before and after POEM for AC patients, and explore the value of HRM in treatment of AC with POEM.Methods 26 cases were diagnosed as achalasia and treated with POEM from January 2018 to December 2019. Pre-operation Eckardt score, esophageal pressure UESP, LESP, 4sIRP, LESL and followed up for 6 months Eckardt score, esophageal pressure UESP, LESP, 4sIRP, LESL were recorded, and analysis of pre-operation and post-operation scores and pressure data whether changes had significant difference and correlation.Results The Eckardt score of 26 patients were (6.50 ± 1.30) and (1.04 ± 0.53), with significant difference (P < 0.05). Pre-operation and post-operation UESP were (50.15 ± 16.74) and (44.70 ± 11.71) mmHg (P > 0.05), no significant difference was observed. LESP were (30.92 ± 10.49) and (17.40 ± 6.14) mmHg and 4sIRP were (22.16 ± 7.75) and (9.45 ± 4.23) mmHg respectively, all had significant difference (P < 0.05). 4sIRP and Eckardt score had significant correlation (r = 0.55, P < 0.05), and type Ⅱ patients had better changes.Conclusion Peroral endoscopic myotomy was safe and effective. Patients with type Ⅱ were better response to treatment，and 4sIRP could evaluate the effect of the treatment.