内镜下食管环行肌切开术治疗贲门失弛缓症15例疗效分析

目的总结经口内镜下食管环行肌切开术(peroral endoscopic myotomy,POEM)治疗贲门失弛缓症的疗效及安全性。方法对15例贲门失弛缓症患者行POEM手术治疗,分别于术后第3天、1个月、6个月和1年评估吞咽困难改善情况及并发症发生情况,对术后吞咽梗阻的改善情况和食管扩张情况进行自身对照比较。结果 15例患者中14例患者均1次手术成功,1例患者因手术过程中血氧饱和度降低,呼吸衰竭,手术终止。14例患者术后吞咽困难消失或明显改善。随访1个月及1年的有效率分别为100%、87%,吞咽梗阻情况改善明显。术前15例患者食管直径(8.3±2.8)cm;POEM术后1个月,食管直径(3.2±0.8)cm;术后6个月,食管直径(3.7±1.2)cm;术后1年,食管直径(3.8±1.2)cm。术前与术后各期相比均有统计学差异(P<0.05),术后1个月与术后6个月、术后6个月与术后1年相比,食管直径均无统计学差异(P>0.05)。结论 POEM作为一种新型的治疗贲门失弛缓症的治疗方法,其短期效果肯定。

Curative effect analysis of peroral endoscopic myotomy in treatment of 15 cases of achalasia

Objective To summarize the efficacy and safety of peroral endoscopic myotomy(POEM) in treatment of achalasia.Methods The clinical data of 15 achalasia patients who underwent peroral endoscopic myotomy were analyzed retrospectively.The improvement of dysphagia and complications were evaluated at 3 day,1 month,6 month and 1 year after operation,respectively.Results In all the 15 patients,14 patients underwent a successful operation.Only one operation was stopped because of the reduction of blood oxygen saturation and respiratory failure during the operation.Dysphagia of the 14 patients was cured or significantly alleviated.The effective rates at 1 month and 1 year after operation were 100% and 87%,respectively.The esophageal diameter before operation was significantly different from that at 1 month,6 months and 1 year after operation [(8.3±2.8) cm vs(3.2±0.8) cm,(3.7±1.2) cm and(3.8±1.2) cm,P<0.05],while the difference of esophageal diameter between two different time points after operation was not significant(P>0.05).Conclusion As a novel approach to achalasia treatment,the POEM has definite curative effect and high safety in a short term.