热活检钳法与传统法经口内镜食管下括约肌切开术治疗贲门失弛缓症的疗效比较

Comparison of therapeutic effect of thermal biopsy forceps and traditional methods in treatment of achalasia by peroral endoscopic myotomy

摘要:

目的 比较使用热活检钳的改良方法与使用三角刀的传统方法，在经口内镜食管下括约肌切开术（POEM）治疗贲门失弛缓症（AC）中的临床疗效。方法 前瞻性纳入2017年2月－2022年2月该院消化内科行POEM治疗的AC患者64例，随机分为热活检钳组和传统方法组，各32例，均行POEM。记录并比较两种手术方式的肌切开与隧道长度、术后住院时间、住院费用、手术时间和并发症发生情况。结果 两组患者均成功完成手术，两组患者手术肌切开长度、隧道长度、气体相关不良事件、住院时间、术后6个月胃食管反流率和术后3个月Eckardt评分比较，差异均无统计学意义（P > 0.05）；但术中出血、手术时间、住院费用和术后6个月Eckardt评分比较，差异均有统计学意义（P < 0.05）。结论 使用热活检钳法与传统法均能有效治疗AC，但热活检钳法能缩短手术时间，减少术中出血和住院费用，且长期疗效可能更显著，尤其适合在技术水平有限的临床机构中推广。

Abstract:

Objective To compare the clinical efficacy of peroral endoscopic myotomy (POEM) with the modified method using thermal biopsy forceps and the traditional method using triangular knife in treatment of achalasia.Methods A prospective study included 64 patients with achalasia who underwent POEM treatment from February 2017 to February 2022. They were randomly divided into the thermal biopsy forceps group and the traditional method group which there were 32 cases in each group, POEM was performed respectively. The length of myotomy and tunnel, postoperative hospital stay, hospitalization cost, operation time and complications were recorded and compared.Results The operation was successfully completed in both groups. There were no significant differences in the length of surgical myotomy, tunnel length, gas-related adverse events, hospital stay, gastroesophageal reflux rate 6 months after surgery and Eckardt score at 3 months after operation between the two groups (P > 0.05). There were significant differences in intraoperative bleeding, operation time, hospitalization cost and Eckardt score at 6 months after operation (P < 0.05).Conclusion Both the thermal biopsy forceps method and the traditional method can effectively treat achalasia, but the thermal biopsy forceps method can effectively shorten the operation time, reduce intraoperative bleeding, and reduce hospitalization cost, and the long-term effect may be more significant, especially suitable for promotion in clinical institutions with limited technical expertise.