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。

Analysis of the effect of peroral endoscopic myotomy in the treatment of senile achalasia

[Objective]To explore the safety and effectiveness of peroral endoscopic myotomy(POEM)in the treatment of elderly patients with achalasia(AC).[Methods]Seventy-seven patients treated with POEM from January 2014 to May 2017 in the affiliated hospital of Qingdao university were retrospectively analyzed.Patients older than 60 years were divided into group A(25 cases)and patients younger than 60 years were divided into group B(52 cases).Baseline data and treatment outcomes were compared between the two groups.[Results]The average age of patients in group A was 60-79(64.92±5.54)years,and the ratio of male to female was 1∶0.93.The average age of patients in group B was 18-59(39.47±11.99)years,and the ratio of male to female was 1∶1.08.The preoperative Eckardt score(t=-0.720,P=0.474),preoperative esophageal pressure(t=-0.117,P=0.908),BMI(t=-0.370,P=0.713),and course of disease(t=1.815,P=0.078)were not statistically significant between the two groups.There were no statistically significant differences in operation duration(t=0.858,P=0.394),average hospital stay(t=1.262,P=0.211)and myotomy length(t=0.261,P=0.795)between the two groups.The incidence of intraoperative complications(X^2=0.705,P=0.784)and gastroesophageal reflux rate(X^2=0.102,P=0.749)were compared between the two groups,and there were no statistically significant difference.The mean follow-up duration was 31 months.The average postoperative Eckardt score of patients in group A(1.12±1.01)and group B(1.11±1.02)showed no significant difference(t=0.004,P=0.997).Postoperative esophageal pressure(17.63±8.57)mmHg in group A and(18.37±9.81)mmHg in group B showed no significant difference(t=0.609,P=0.544).[Conclusions]POEM is a safe and effective operation in the treatment of senile AC.