【摘要】 目的探讨经口内镜下食管肌切开术(POEM)治疗贲门失弛缓症(AC)的疗效和并发症。方法 2011年7月至2013年2月山东大学附属临沂市人民医院41例AC患者接受POEM治疗并经1~2年的随访。观察手术并发症,比较手术前后患者临床症状评分,观察手术前后患者钡餐造影的改善情况。结果所有41例AC患者均成功接受POEM,手术时间35~110 min,平均(67±24)min,黏膜下隧道长度8~12 cm,环形肌切开长度7~10 cm。皮下气肿发生率为20%(8/41),胸腔积液发生率为12%(5/41),其中1例患者并发气胸,1例患者并发双侧较多胸腔积液,均行胸腔引流,经治疗后痊愈。随访13~26个月,平均随访(21.2±4.7)个月。术前平均Eckardt评分为(7.18±1.42)分,随访结束时平均Eckardt评分为(0.73±1.00)分,较术前下降,且差异有统计学意义(Z=-2.93,P=0.00)。随访结束时症状缓解率为100%(41/41),完全缓解率为83%(34/41)。术后食管造影可见钡剂通过顺畅。结论短期随访的证据表明POEM是一种治疗AC的有效方法。更多还原

【Abstract】 Objective To evaluate the efficacy and complications of peroral endoscopic myotomy( POEM) for achalasia of cardia( AC). Methods Forty-one patients were diagnosed as AC and received POEM in Linyi People’ s Hospital affiliated to Shandong University from July 2011 to February 2013. The complications were evaluated and the improvements of clinical symptoms and barium meal were investigated by follow-up for 1 to 2 years. Results All the patients underwent POEM successfully. The mean operation time was( 67 ± 24) minutes( ranging 35-110 minutes). The submucosal tunneling length was between 8 cm and 12 cm and the length of endoscopic myotomy of circular muscle was between 7 cm and 10 cm.Subcutaneous emphysema occurred in 8 patients( 20%) and pleural effusion appeared in 5 patients( 12%). Most patients recovered without specific interventions except two patients who had apparent pneumothorax and bilateral pleural effusion postoperatively. Both patients were cured by thoracic drainage.The average symptom score was changed from( 7. 18 ± 1. 42) scores preoperatively to( 0. 73 ± 1. 00) scores at the end of follow-up and the difference was statistically significant( Z =- 2. 93,P = 0. 00). The rate of symptoms relief was 100%( 41 /41) after a mean follow-up duration of 21 months and 34 patients( 83%)had complete relief of symptoms. Radiographic improvement was also noted on barium esophagram for the patients. Conclusion POEM is an effective treatment for AC although it has certain complications.更多还原