【摘要】 目的对比球囊扩张术(PD)与经口内镜下肌切开术(POEM)的疗效。方法本研究为回顾性研究,纳入了由2011年7月到2013年7月总共102例明确诊断为贲门失弛缓症的患者。其中77例患者接受了POEM,另外25例患者接受了PD。观察并对比两组患者术前术后症状缓解情况、下段食管括约肌压力、手术时长、术中和术后并发症、手术风险以及住院时长等。结果 POEM组含有77例患者,而PD组有25例患者。经过一系列术前检查,发现两组患者之间的BMI、性别、年龄以及术前的食管测压、Eckardt评分并没有存在显著差异。术后3个月时两组患者均获得明显的临床缓解,POEM组患者的Eckardt评分(1.40±1.20 vs.1.48±1.42,P<0.777)以及术后LES压力[(14.45±6.14)mm Hg vs.(16.84±7.34)mm Hg,P<0.874]和PD组相比并没有统计学差异。而POEM组患者的手术耗时[(60.54±24.02)min vs.(23.91±3.68)min,P<0.00]、住院时长[(9.49±4.45)d vs.(5.76±2.26)d,P<0.00]以及术中并发症发生率(18.2%vs.0%,P=0.00)均要显著高于PD组。但术后12个月时的随访复查发现PD组的Eckardt评分(1.18±1.08 vs.4.23±2.06,P<0.00)和LES压力[(13.42±5.56)mm Hg vs.(38.27±9.13)mm Hg,P<0.00]显著高于POEM组。结论相比POEM术,PD术简单易行,安全性相对较高,且两者对于治疗贲门失弛缓症都有良好的短期疗效。但对于PEOM患者,症状缓解更加稳定,症状不会复发。而接受PD治疗的患者,往往未来需要接受重复或更进一步治疗。更多还原

【Abstract】 Objective To compare the outcomes of peroral endoscopic myotomy and pneumatic dilation for achalasia. Methods This retrospective study involved 102 patients in Nanfang Hospital from July 2011 to July 2013. All these patients were finally diagnosed achalasia of cardia. 77 patients underwent POEM and the rest received PD. We compared statistics from both teams, including Eckardt score for symptoms relief, LES pressure, length of procedure, complications and so on. Results Before treatments, patients from two groups were match in terms of BMI, sex, age, Eckardt score and LES pressure. About the treatments, because of the complexity of POEM, length of procedure,(60.54±24.02)min vs.(23.91±3.68)min, P<0.00, length of hospital stay(9.49±4.45)d vs.(5.76±2.26)d, P<0.00, and incidence of complications(18.2% vs. 0%, P=0.00) were significantly higher than PD group. In 3 months after treatments, there was no difference in Eckardt scores(1.40±1.20 vs. 1.48±1.42, P<0.777) and LES pressure,(14.45±6.14) mm Hg vs.(16.84±7.34) mm Hg, P<0.874, from POEM group and PD group. However, Eckardt scores(1.18±1.08 vs. 4.23±2.06, P<0.00) and LES pressure,(13.42±5.56) mm Hg vs.(38.27±9.13) mm Hg, P<0.00, were significantly higher for the PD group in 1 year follow-up. Conclusion PD is easier and safer for both endoscopists and patients, both POEM and PD achieve satisfying symptoms relief in the short time after treatments, but POEM tends to provide a more stable outcome. For those undergoing PD, symptoms relapse will take place in the near future. In this case, further treatments will be inevitable.更多还原