经口内镜下肌切开术治疗贲门失驰缓症疗效观察

目的观察经口内镜下肌切开术(POEM)对贲门失弛缓症(AC)的治疗效果。方法回顾性分析2013年8月至2013年11月本院诊断为AC并接受POEM治疗的3例患者的临床资料,总结术中、术后以及随访过程中并发症的发生及治疗情况。结果所有3例患者均成功接受POEM术,仅1例在术中出现皮下气肿,术后2小时后气肿消退。术后随访1~3个月,3例患者吞咽困难得到明显缓解。结论 POEM治疗AC近期疗效肯定,可以迅速缓解AC患者吞咽困难,远期疗效有待进一步随访。     

经口内镜下肌切开术术后一过性菌血症的发生率

目的研究经口内镜下肌切开术（POEM）术后一过性菌血症的发生率,为POEM的进一步发展及推广提供理论依据。方法前瞻性地连续选择2013年6月5日至2013年7月11日间行POEM患者12例。术后5min、30min、6h、16h分别抽血行血培养及血常规、C-反应蛋白检测,记录体温,同时密切监测患者术后感染相关并发症。结果除1例患者因术中出血,止血后终止手术,余11例患者成功完成手术,其中1例在术后5min血培养中培养出革兰阳性杆菌,而在随后的30min、6h、16h血培养中转为阴性;其余患者血培养均为阴性。同时,患者术后白细胞计数、中性粒细胞比例及C-反应蛋白均有不同程度的升高,且以中性粒细胞的升高最为明显（P〈0．001）,而体温变化方面的差异并不显著（P〉0．05）。结论POEM术后存在一过性菌血症,但其具体发生率及最终结论尚需大样本进一步研究。     

经口内镜下环形肌切开术治疗老年贲门失弛缓症的疗效

目的 探索经口内镜下环形肌切开术（POEM）治疗老年贲门失弛缓症（AC）的安全性、可行性、围手术期及远期疗效。 方法 回顾性分析2010年8月至2014年12月期间在复旦大学附属中山医院确诊为AC并接受POEM治疗、可获得完整随访资料的老年（≥65岁）患者共41例,观察手术相关并发症、治疗前后Eckardt评分及食管下段括约肌压力变化,并分析远期食管反流及治疗失败的发生情况。 结果 41例患者均成功完成POEM手术,中位手术时间42 min,中位住院天数为3 d,共4例（975%）患者出现主要围手术期不良事件,均为因围手术期不良事件导致住院时间长于5 d。中位随访时间40个月（四分位数区间 24~57个月）,Eckardt评分中位数从术前8分下降为术后1分（P<0001）,食管下段括约肌压力中位数从术前2385 mmHg (1 mmHg=0133 kPa) 下降为术后905 mmHg (P=0005)。术后随访12例（2927%）患者出现临床反流,5年临床治疗成功率8780%(36/41)。 结论 POEM治疗老年AC患者安全可靠,近期和远期疗效均较好。     

经口内镜下肌切开术不同术式治疗贲门失弛缓症的比较

目的 探讨采用不同经口内镜下肌切开术（peroral endoscopic myotomy,POEM）术式治疗贲门失弛缓症的优劣。 方法 回顾性分析2015年1月至2018年9月于郑州大学第一附属医院消化内科行POEM治疗并定期随访的223例贲门失弛缓症患者的病例资料,其中采用传统POEM治疗100例,Liu-POEM治疗60例,简化POEM治疗60例,O-POEM治疗3例,对比这4种术式的手术前后症状评分（Eckardt评分）、手术时间、并发症及复发情况。 结果 这4种POEM手术成功率均为100%,且术后1个月、6个月、12个月时Eckardt评分均≤3分,均较术前显著降低,差异有统计学意义（P＜0.05）。传统POEM、Liu-POEM和简化POEM组间比较差异无统计学意义（P＞0.05）。与传统POEM相比,Liu-POEM和简化POEM手术时间和皮下气肿的发生率显著降低,差异有统计学意义（P＜0.05）。O-POEM手术时间最短,无皮下气肿。所有患者术后无复发。 结论 这4种POEM治疗贲门失弛缓症均具有较好疗效,Liu-POEM和简化POEM相比传统POEM具有操作较简单、手术时间较短、并发症发生率较低的优点。对于既往有外科手术史、反复球囊扩张、POEM术后复发等黏膜下粘连而无法建立黏膜下隧道的患者,可考虑O-POEM作为补救治疗。     

经口内镜下肌切开术治疗贲门失弛缓症中远期疗效分析

贲门失弛缓症(AC)是一种较为罕见的痉挛性食管动力障碍疾病.经口内镜下肌切开术(POEM)作为内镜微创手段,已经成为该病的一线治疗方法.目前针对POEM的术后疗效分析以短期随访居多.为进一步评价POEM治疗AC的长期疗效及安全性,并总结可能影响POEM治疗AC长期疗效的相关因素,本文就POEM治疗AC术后随访3年以上的...     

透明帽在经口内镜下肌切开术中的应用价值

目的初步探讨透明帽在经口内镜下肌切开术中的应用价值。方法回顾性分析2011年7月-2013年7月由同一操作者采用透明帽辅助的经口内镜下肌切开术治疗54例贲门失驰缓症患者,统计手术时间、手术成功率、并发症发生率、患者住院时间等。结果共54例贲门失驰缓症患者行经口内镜下肌切开术,成功54例,手术成功率100%,16例出现术中或术后并发症,并发症发生率为29.6%,手术时间45~396 min,平均(125±61)min,患者住院时间为5~28 d,平均(13.0±4.5)d。结论透明帽应用于经口内镜下肌切开术安全、方便、有效,能够缩短手术操作时间,提高手术成功率,降低并发症发生率,缩短患者住院时间。     

经口内镜下环形肌切开术治疗老年贲门失弛缓症的疗效分析

[目的]探讨经口内镜下环形肌切开术(peroral endoscopic myotomy,POEM)治疗老年贲门失弛缓症(achalasia,AC)的安全性及有效性。[方法]对2014-01—2017-05期间入青岛大学附属医院行POEM治疗的77例AC患者进行回顾性分析,将年龄≥60岁的患者分为A组(25例),60岁的患者分为B组(52例)。比较2组患者的基线资料及治疗效果。[结果]A组患者年龄60～79(64.92±5.54)岁,男女比例1∶1.08;B组患者年龄18～59(39.47±11.99)岁,男女比例1∶0.93;2组术前Eckardt评分(t=-0.720,P=0.474)、术前食管测压(t=-0.117,P=0.908)、BMI(t=-0.370,P=0.713)、病程(t=1.815,P=0.078)比较,均差异无统计学意义。2组手术时间(t=0.858,P=0.394)、平均住院时间(t=1.262,P=0.211)、肌切开长度(t=0.261,P=0.795)比较,均差异无统计学意义。2组术中并发症发生率(X~2=0.075,P=0.784)、胃食管反流率(X~2=0.102,P=0.749)比较,均差异无统计学意义。平均随访31个月,A组患者术后Eckardt评分平均(1.12±1.01)分,B组(1.11±1.02)分,2组比较差异无统计学意义(t=0.004,P=0.997);A组术后食管压力(17.63±8.57)mmHg,B组术后(18.37±9.81)mmHg,2组比较差异无统计学意义(t=0.609,P=0.544)。[结论]POEM用于老年AC的治疗是安全、有效的。     

经口内镜下食管肌切开术治疗贲门失驰缓症的相关研究

<正>食管-贲门失驰缓症(esophageal achalasia AC)又称贲门痉挛、巨食管,是食管一种神经肌肉功能障碍所致的疾病,主要特征是食管缺乏蠕动,食管下端括约肌(LES)高压和对吞咽动作的松弛反应减弱。据流行病学调查其发病率为0.0005%,患病率为0.008%,多发生于中年人,近年来发病率有上升趋势[1],其病因迄今不明,一般认为,本病属神经源性疾病。病变可见食管壁内迷走神经及其背核和食管壁肌间神经丛中神经节细胞减少,以食管体部明显,     

再次经口内镜下肌切开术治疗持续/复发贲门失驰缓症的临床价值

目的 评估在首次POEM失败后再次经口内镜下肌切开术（再次POEM ）作为补救治疗的可行性,安全性和有效性。方法 33例首次POEM后仍出现持续/复发症状的患者(Eckardt 症状评分≥4) 被回顾性地从一个 维护数据库中选择出来,这个数据库中共有2516例贲门失弛缓症患者。主要指标是随访期间症状缓解, Eckardt评分≤3。次要观察指标是手术相关不良事件, 食管下括约肌 (LES) 压力的变化, 以及再次POEM治疗前后的反流症状。结果 所有患者在首次行POEM后平均18.6个月(3~55个月)成功进行了再次POEM。平均手术时间为45.1 min（28~64 min）。通过保守治疗成功地处理了一例黏膜下隧道感染。在平均随访期间36.6个月 (12~58个月), 所有患者达到了症状缓解 。在再次POEM 前平均症状评分为 5.5分(4~8分),处理后平均1.3分(范围：0~3分;P<0.001)。再次POEM后, 平均食管下括约肌压力也从26.0 mmHg下降到9.6 mmHg (P<0.001)。再次POEM的临床反流并发症发生率为33.3%（11/33） 。结论 在首次POEM失败后,再次POEM看起来安全有效,作为一种补救方案,可以使所有患者短期症状缓解并且无严重并发症。     

经口内镜下肌切开术治疗贲门失弛缓症疗效分析

目的探讨经口内镜下肌切开术（POEM）治疗贲门失弛缓症的疗效及安全性。方法对40例贲门失弛缓症患者进行POEM治疗,手术前后评估症状及食管造影、食管测压、胃镜等检查,于术后第6天、1个月、3个月、6个月评估疗效,并观察手术并发症。结果40例贲门失弛缓症患者均顺利完成POEM,手术时间（57．2±18．4）min,术中有2例出现纵隔和皮下气肿。术后缓解率100％（Eekardt评分≤3分）,平均随访13．3个月,复发2例,半年缓解率90％。食管测压术前食管下括约肌平均静息压30．6mmHg（1mmHg=Q133kPa）,术后15．8mmHg（P=0.001）;术前平均综合松弛压28．1mmHg,术后12．2mmHg（P=0．000）;平均食管最宽径术前4．2cm,术后3．1cm（P〈0．001）。结论POEM治疗贲门失弛缓症安全、有效,短期疗效肯定,并发症少,长期疗效及远期并发症有待随访研究。     

经口内镜下肌切除术治疗贲门失弛缓症的临床疗效观察

目的 观察经口内镜下肌切除术(POEM)治疗贲门失弛缓症的临床疗效和安全性.方法 对2010年11月至2011年11月7例确诊为贲门失弛缓症的患者行POEM手术.记录术前吞咽困难评分、术后并发症及近期远期疗效.结果 7例患者POEM手术均成功.手术时间46～113 min,平均(73±20) min.术后除2例出现皮下气肿、纵隔气肿,经内科治疗后痊愈,余均未出现相关并发症.术后随访1～12个月,7例患者吞咽困难均得到明显改善.结论 POEM手术可以迅速解除贲门失弛缓症患者吞咽困难,且具有一定的安全性.     

环形肌切开和全层肌切开治疗贲门失弛缓症长期随访研究

目的：对比内镜下全层肌切开与环形肌切开治疗贲门失弛缓症的长期临床疗效及远期并发症。方法：回顾性分析2012年6月至2014年12月于郑州大学第一附属医院消化内科行经口内镜下肌切开术治疗并定期随访的53例贲门失弛缓症患者资料,其中21例行环形肌切开,32例行全层肌切开,比较两种术式的长期临床疗效及远期并发症。 结果：环形肌切开组和全层肌切开组治疗有效率分别为90.5%（19/21）和100%（32/32）。两组术后Eckardt评分、食管下括约肌压力和4 s完整松弛压比较差异无统计学意义（P>0.05）。全层肌切开组临床相关胃食管反流发生率高于环形肌切开组（40.6％比14.3%,χ2=4.174,P=0.041）。 结论：经口内镜下环形肌切开术与全层肌切开术治疗贲门失弛缓症长期疗效相当,但全层肌切开术后临床相关胃食管反流发生率更高。     

Effect of peroral esophageal myotomy for achalasia treatment: A Chinese study

AIM: To assess the safety and feasibility of peroral esophageal myotomy(POEM) in patients with achalasia.METHODS: From January 2012 to March 2014, 50 patients(28 men, 22 women; mean age: 42.8 years, range: 14-70 years) underwent POEM. Pre- and postoperative symptoms were quantified using the Eckardt scoring system. Barium swallow and esophagogastroscopy were performed before and after POEM, respectively. Esophageal motility was evaluated in all patients, both preoperatively and one month after POEM treatment, using a high-resolution manometry system. Manometry data, Eckardt scores, lower esophageal sphincter pressure and barium swallow results were used to evaluate the effect of the procedure.RESULTS: POEM was successfully completed for all patients. The mean procedure time was 55.4 ± 17.3 min and the mean total length of myotomy of the circular esophagus was 10.5 ± 2.6 cm. No specific complications occurred, with the exception of two patients that developed as ymptomatic pneumomediastinum and subcutaneous emphysema. Clinical improvement in symptoms was achieved in all patients. Approximately 77.5% of patients experienced weight gain 6 mo after POEM, with an average of 4.78 kg(range: 2-15 kg). The lower esophageal sphincter resting pressure, four second integrated relaxation pressure and Eckardt scores were all significantly reduced after POEM(Ps 0.05). A small segment of proximal esophageal peristalsis appeared postoperatively in two patients, but without normal esophageal peristalsis. The average diameter of the esophageal lumen decreased significantly from 4.39 to 3.09 cm(P 0.01). CONCLUSION: POEM can relieve achalasia symptoms, improve gastroesophageal junction relaxation and restore esophageal body motility function, but not normal esophageal peristalsis.     

New endoscopic classification of achalasia for selection of candidates for peroral endoscopic myotomy

AIM:To propose a new endoscopic classification of achalasia for selecting patients appropriate for undergoing peroral endoscopic myotomy(POEM).METHODS:We screened out the data of patients with achalasia examined from October 2000 to September 2011 at our Digestive Endoscopic Center with endoscopic pictures clear enough to reveal the morphology of middle and lower esophagus.After analyzing the correlation between the endoscopic morphology of the esophageal lumen and POEM,we proposed a new endoscopic classification(Ling classification) of achalasia according to three kinds of endoscopically viewed structures:multi-ring structure,crescent-like structure and diverticulum structure.There were three types based on the criteria of Ling classification:type Ⅰ,smooth without multi-ring,crescent-like structure or diverticulum structure;type Ⅱ,with multi-ring or crescent-like structure but without diverticulum structure;and type Ⅲ,with diverticulum structure.Type Ⅱ was classified into three subtypes:Ling Ⅱa,Ling Ⅱb and Ling Ⅱc;and type Ⅲ also had three subtypes:Ling Ⅲl,Ling Ⅲr and Ling Ⅲlr.Two endoscopists made a final decision upon mutual agreement through discussion if their separately recorded characteristics were different.RESULTS:Among the 976 screened patients with achalasia,636 patients with qualified endoscopic pictures were selected for the analysis,including 405 males and 231 females.The average age was 42.7 years,ranging from 6 to 93 years.Type Ⅰ was the most commonly observed type of achalasia,accounting for 64.5%(410/636),and type Ⅲ was the least commonly observed type of achalasia,accounting for 2.8%(18/636).And type Ⅱ accounted for 32.7%(208/636) and subtype of Ling Ⅱa,Ling Ⅱb and Ling Ⅱc accounted for 14.6%(93/636),9.9%(63/636) and 8.2%(52/636),respectively.And subtype of Ling Ⅲl,Ling Ⅲr and Ling Ⅲlr accounted for 0.8%(5/636),0.3%(2/636) and 1.7%(11/636),respectively.CONCLUSION:A new endoscopic classification of achalasia is proposed that might help in determining the     

横开口法内镜下食管肌层切开术治疗贲门失驰缓症的术后处理

目的探讨隧道横开口法内镜下食管肌层切开术治疗贲门失驰缓术后的合理处理方法。方法分析53例贲门失驰缓症患者术前、术中、术后护理。结果术后正确的饮食指导及并发症的观察是治疗的关键。53例患者治疗成功率100%,无1例发生纵膈气肿、气胸、食管纵膈瘘。结论隧道横开口法内镜下食管肌层切开术治疗贲门失驰缓症方法安全有效,术后正确的饮食指导、并发症的观察是治疗成功的关键。     

Endoscopic ultrasound-measured muscular thickness of the lower esophageal sphincter and long-term prognosis after peroral endoscopic myotomy for achalasia

BACKGROUND People with achalasia typically have a thick lower esophageal muscularis propria(LEMP), and peroral endoscopic myotomy(POEM) has been effective in treating most patients. LEMP thickness may be associated with the outcomes and prognosis after POEM. However, more evidence is needed regarding the relationship between LEMP thickness and patient prognosis after POEM.AIM To assess the association between LEMP thickness, measured using endoscopic ultrasound(EUS), and long-term prognosis, especially relapse, after POEM for achalasia.METHODS All medical records, including EUS data, of patients who underwent POEM to treat achalasia at Shengjing Hospital of China Medical University from January 2012 to September 2018 were retrospectively reviewed. LEMP thickness was measured by EUS, and a thickness of ≥ 3 mm was defined as thickened. The severity of patient symptoms was evaluated using the Eckardt score. Relapse was defined as a 3-point rise in the Eckardt score after a period of clinical remission. The relationship between patient characteristics, muscle thickness, and recurrence was analyzed.RESULTS Eighty-two patients(32 males and 50 females, aged 17-78 years) and 85 POEM procedures were included. In total, 76.8%(63/82 patients) of patients had a thickened muscularis propria. Older age and longer disease course were associated with muscularis propria thickening(P 0.05). The mean postoperative follow-up time was 35.4 ± 17.2 mo(range, 8-87.5 mo) in 60 patients. Five patients with Eckardt scores 3 refused further management after their symptoms were relieved. The relapse rate was 12.73%(7/55 cases). Five patients, four of whom had muscularis propria thickening, had disease recurrence within 12 mo after the procedure. Achalasia relapsed in one patient who had a thickened muscularis propria after 24 mo and in another patient who did not have a thickened muscularis propria after 30 mo. Patients with recurrence were typically younger and had a shorter disease course(P 0.05). The relapse rate in patients with a non-thickened muscularis propria tended to be higher(18.2%, 2/11 patients) than that in patients with a thickened muscularis propria(11.4%, 5/44 patients), although no significant difference was found. Age(hazard ratio = 0.92; 95% confidence interval: 0.865-0.979; P 0.05) and being male(hazard ratio = 7.173; 95% confidence interval: 1.277-40.286; P 0.05) were identified as risk factors for symptomatic recurrence by multivariable analysis using the Cox model.CONCLUSION Patients with a thickened muscularis are typically older and have a longer disease course. Younger age and the male sex are associated with increased recurrence. Patients with a thin muscularis propria may be prone to relapse, although further validation is needed.     

经口内镜下肌切开术对贲门失弛缓症患者食管动力的影响

目的探讨经口内镜下肌切开术(peroral endoscopic myotomy,POEM)初次治疗对贲门失弛缓症(achalasia,AC)患者术后食管动力的影响。方法纳入2012年1月至2016年6月期间于首都医科大学附属北京友谊医院就诊并行POEM治疗的AC患者,按研究设计完成各项检查、POEM治疗及随访观察,比较各型AC患者的POEM治疗成功率以及POEM治疗前后食管动力的改变。结果POEM术后6个月随访时,Ⅰ型AC患者的症状缓解率为100.0%(13/13),Ⅱ型为95.5%(42/44),Ⅲ型为90.1%(10/11)。与术前比较,术后1~6个月内下食管括约肌静息压[10.5(6.9,15.8)mmHg比24.6(18.3,35.1)mmHg,1 mmHg=0.133 kPa]、4 s整合松弛压[6.0(3.7,8.8)mmHg比21.8(15.3,28.0)mmHg]、上食管括约肌静息压[43.4(33.7,57.3)mmHg比45.3(33.2,71.1)mmHg]、上食管括约肌残余压[1.5(0.0,4.6)mmHg比3.9(1.1,6.9)mmHg]均明显改善(P均<0.05)。术后6个月,食管腔扩张的最宽直径较术前明显减小[(3.0±0.7)cm比(3.9±1.1)cm,P<0.001],总Eckardt评分较术前明显降低[1(0,2)分比6(5,8)分,P<0.001]。POEM术后,Ⅰ型AC患者食管体部均未出现蠕动恢复,Ⅱ型AC患者中有4例(9.1%,4/44)较术前恢复弱蠕动或期前收缩,Ⅲ型AC患者中10例(90.9%,10/11)较术前出现正常蠕动波、期前收缩或弱蠕动的比例增加。结论POEM术后不仅食管胃交界部流出道梗阻得到改善,而且食管体部动力也一定程度上发生改变,其中部分患者体部动力有一定恢复;但是这种变化在3个AC亚型表现不同,Ⅲ型最明显,其次是Ⅱ型,Ⅰ型则无明显改变。     

经口内镜肌切开术治疗贲门失弛缓症的实验及临床经验初探

目的利用猪食管-胃模型进行经口内镜肌切开术（POEM）实验,为临床开展POEM术积累经验并探讨POEM治疗贲门失弛缓症的安全性和有效性。方法止血钳结扎离体猪的胃幽门出口,并将离体猪的食管口侧末端固定于带孔泡沫塑料,制成简易训练模型,然后以带透明帽内镜按如下步骤进行POEM术：（1）建立黏膜下隧道;（2）切断食管环形肌层;（3）封闭隧道口。经模型练习熟练掌握POEM技巧后,对4例贲门失弛缓症患者实施手术。结果5例猪食管-胃模型,2例成功完成POEM术,1例食管纵行肌层裂开穿孔,1例切断环形肌层时切除过深导致穿孔,1例于食管一胃连接部切破黏膜层。经模型练习后在临床成功开展POEM术4例,操作时间平均110min,隧道长度8—11cm,平均10．5cm,环形切断长度5～8cm,平均7cyn,术中1例出血较多,但在内镜下成功止血。食管测压提示,术后平均LES压力从术前47．07mmHg降至17．4mmHg。术后随访1～4个月,4例患者吞咽困难症状明显缓解。结论猪食管-胃模型制作简单,可作为简易的训练模型模拟POEM术过程。POEM术治疗贲门失弛缓症近期疗效肯定,远期疗效有待进一步随访。     

经口内镜肌切开术对贲门失弛缓症患者食管动力的影响

目的探讨经口内镜肌切开术（POEM）对贲门失弛缓症患者食管动力的影响。方法对3例贲门失弛缓症患者POEM治疗前后的食管测压结果进行对比分析。结果术后3例患者食管下括约肌压力（LESP）和食管上括约肌残余压（UESRP）均低于术前,且差异有统计学意义（P〈0．05）;术后食管下括约肌残余压（LESRP）有2例明显降低至正常值,有1例变化不大,仍高于正常,平均值较术前降低但差异无统计学意义;术前3例患者均有食管蠕动波消失,术后食管蠕动波均无改善;3例患者术前食管下括约肌松弛率（LESRR）均低于正常值,术后仍均低于正常;食管上括约肌压（UESP）平均值术后较术前降低,但差异无统计学意义。结论POEM近期能明显改善贲门失弛缓症患者的食管动力学特征。