短隧道 POEM 术在治疗 Ling IIc 型贲门失弛缓症中的作用

目的：通过研究短隧道经口内镜下肌切开术（POEM）在治疗 Ling IIc 型贲门失弛缓症（AC）中的作用，为 POEM 术的术式探索及发展提供进一步的理论依据。方法回顾性的研究自2010年11月1日至2014年4月4日在解放军总医院消化内镜中心成功实施 POEM 的25例 Ling IIc型 AC 患者，将其根据隧道开口位置分为短隧道组（A 组）和标准隧道组（B 组），并对比两组短期临床疗效、手术时间、隧道长度、肌切开长度及并发症情况。结果 A、B 两组（A 组14例，B 组11例）在术前 Eckardt 评分、术后体重增加值、隧道长度、肌切开长度方面均有统计学差异，术后 Eckardt 评分差异则不显著。术后共有5例患者发生气体相关并发症，其中 A 组1例（气腹＋皮下积气），B 组4例（纵膈积气＋皮下积气1例、气胸＋皮下积气1例、单纯皮下积气2例）。结论针对 Ling IIc 型 AC 患者实施短隧道 POEM 术初步证实是安全有效的，但其最终结论尚需大样本研究予以证实。

Application of peroral endoscopic myotomy with short tunnel for Ling IIc type achalasia

Objective To investigate the application of peroral endoscopic myotomy（POEM）with short tunnel for Ling IIc type achalasia so that it could provide the theoretical basis for the exploration of the surgical approach and the further development of POEM. Methods We conducted a retrospective study of 25 patients with Ling IIc type achalasia undergoing POEM in our digestive endoscopy center between Nov. 1, 2010 and Apr. 4,2014. The 25 patients were divided into the short tunnel group（ group A）and the standard tunnel group（group B）according to the position of tunnel entry incision. Then we compared the short-term clinical efficacy,operative time,length of the tunnel,length of the muscle incision and complications between the two groups. Results There were statistical differences between group A and B （14 cases in group A,11cases in group B）in the preoperative Eckardt scores,post-operative weight gain values,length of the tunnel and the length of the muscle incision. But the differences in post-operative Eckardt scores were not significant. There were 5 cases of postoperative complications in patients with gas, 1 case in group A （ pneumoperitoneum and subcutaneous pneumatosis ）, 4 cases in group B （ pneumomediastinum and subcutaneous pneumatosis 1 case, pneumoperitoneum and subcutaneous pneumatosis 1 case,subcutaneous pneumatosis 2 cases）. Conclusion The security and effectiveness of POEM with short tunnel for Ling IIc type AC is initially confirmed,but the final conclusions need to be proved by large sample studies.