不同隧道开口法经口内镜下肌切开术治疗贲门失弛缓症的效果评价

Evaluation of the effect of peroral endoscopic myotomy with different tunnel opening methods on achalasia

摘要:

目的 比较纵开口法与倒“T”形开口法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 回顾性分析2016年1月－2019年12月于青岛大学附属烟台毓璜顶医院行POEM治疗的55例AC患者的临床资料，包括患者一般情况、贲门失弛缓症临床症状评分（Eckardt评分）和术中术后短期并发症发生情况等。结果 55例患者均顺利完成POEM，平均随访（10.67±2.80）d，术后Eckardt评分较术前明显改善［2（2，2）和4（4，5）分，P < 0.05］，症状缓解率为98.2%（54/55）。纵开口法组总并发症发生率明显高于倒“T”形开口法组［44.8%（13/29）和15.4%（4/26），P < 0.05］，其中气体相关并发症发生率更为明显［34.5%（10/29）和7.7%（2/26），P < 0.05］。纵开口法组中有1例术中发生黏膜裂伤和穿孔，1例出现复发。结论 倒“T”形开口法POEM不仅可以有效缓解患者临床症状，还能降低术中和术后短期并发症的发生率。

Abstract:

Objective To compare the clinical effect of longitudinal opening method and inverted T opening method in treatment of patients with achalasia (AC) by peroral endoscopic myotomy (POEM).Methods Clinical data of 55 patients with AC who underwent POEM treatment from January 2016 to December 2019 were retrospectively analyzed, including the patient's general condition, Eckardt score, and intraoperative and postoperative short-term complications, etc.Results 55 patients successfully completed POEM, with an average follow-up of (10.67 ± 2.80) d. The postoperative clinical symptom scoring system for achalasia of cardia (Eckardt score) was significantly improved compared with preoperation [2 (2, 2) vs 4 (4, 5), P < 0.05)], the symptom relief rate was 98.2% (54/55). The total complication rate of the longitudinal opening method group was markedly higher than that of the inverted T opening method group [44.8% (13/29) vs 15.4% (4/26), P < 0.05], the incidence of gas-related complications was more obvious [34.5% (10/29) vs 7.7% (2/26), P < 0.05]. There was one case of mucosal laceration and perforation during operation, and one case had recurrence in the longitudinal opening group.Conclusion The inverted T opening method POEM can not only effectively relieve the clinical symptoms of patients, but also reduce the incidence of short-term complications during and after operative treatment.