再次经口内镜下肌切开术治疗贲门失弛缓症的疗效观察

Clinical evaluation of repeat peroral endoscopic myotomy for achalasia

摘要:

目的 探讨初次经口内镜下肌切开术（POEM）治疗贲门失弛缓症（AC）失败后，再次POEM手术的可行性、有效性及安全性。方法 选择2018年2月－2020年8月郑州大学第一附属医院收治的10例初次POEM治疗失败再次接受POEM治疗的AC患者，观察手术成功率、手术时间、术后住院时间、并发症、住院费用以及随访情况等相关指标，并对其进行统计学分析。结果 所有患者均成功完成了再次POEM手术。与初次POEM相比，再次手术在住院总费用、术后住院时间、手术时间、术后禁食时间等方面无明显差异；先后两次手术均无穿孔、胸腔积液、气体相关并发症等不良事件发生，在黏膜损伤、胸痛、发热、迟发性出血等方面也相当（P > 0.05）。中位随访时间8.5个月（5～28个月），再次POEM术前平均Eckardt评分5.6分（4～8分），术后Eckardt评分均 ≤ 3分，平均1.4分（1～3分）。3例患者出现临床相关胃食管反流病（GERD），其中1例复查胃镜提示反流性食管炎。结论 初次POEM治疗AC失败后，再次POEM手术仍安全有效。

Abstract:

Objective To evaluate the feasibility, efficacy and safety of after initial peroral endoscopic myotomy (POEM) failure and repeated peroral endoscopic myotomy (Re-POEM) procedure for achalasia.Methods From February 2018 to August 2020, 10 patients with achalasia who failed after initial POEM and Re-POEM were performed in our center. The success rate, operation time, postoperative hospital length of stay, complications, total cost of hospitalization and follow-up were observed and statistically analyzed.Results Re-POEM procedures were conducted successfully in all the patients. Compared with the initial POEM, there were no statistically significant differences in operation time, postoperative fasting time, postoperative hospital length of stay and total cost of hospitalization. In terms of complications, there were no perforation, pleural effusion, gas-related complications in the two operations, and the incidence of mucosal injury, chest pain, fever, delayed bleeding were comparable (P > 0.05). After a median follow-up of 8.5 months (5～28 months), the Eckardt scores of all patients after Re-POEM were ≤ 3, with an average of 1.4 (1～3 Points). 3 patients developed clinically related gastroesophageal reflux disease (GERD), of which 1 case showed reflux esophagitis by gastroscopy.Conclusion Re-POEM is still safe and effective as a remedy for patients who underwent initial POEM for achalasia and presenting with either persistent or recurrent dysphagia.