经口内镜下肌切开术（POEM）与腹腔镜 Heller 肌切开术的围手术期结果比较。
Comparison of perioperative outcomes between peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy.
机构信息
Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 650, Chicago, IL 60611, USA.
出版信息
J Gastrointest Surg. 2013 Feb;17(2):228-35. doi: 10.1007/s11605-012-2030-3. Epub 2012 Sep 28.
BACKGROUND
Peroral esophageal myotomy (POEM) is a novel endoscopic operation for the treatment of achalasia. Few POEM outcome data exist, and no study has compared POEM with the surgical standard, laparoscopic Heller myotomy (LHM).
METHODS
Perioperative outcomes were compared between POEM and LHM performed in a nonrandomized fashion. Patients in both groups met the following eligibility criteria: diagnosis of achalasia, age 18-85, and absence of prior achalasia treatment.
RESULTS
Eighteen patients underwent POEM, and 55 patients underwent LHM. Operative times were shorter for POEM (113 vs. 125 min, p < .05), and estimated blood loss was less (≤10 ml in all cases vs. 50 ml, p < .001). Myotomy lengths, complication rates, and length of stay were similar. Pain scores were similar upon post-anesthesia care unit arrival and on postoperative day 1 but were higher at 2 h for POEM patients (3.5 vs. 2, p = .03). Narcotic requirements were similar, although fewer POEM patients received ketorolac. POEM patients' Eckardt scores decreased (median 1 postop vs. 7 preop, p < .001), and 16 (89 %) patients had a treatment success (score ≤3) at median 6-month follow-up. Six weeks after POEM, routine follow-up manometry and esophagram showed normalization of esophagogastric junction pressures and contrast column heights.
CONCLUSIONS
POEM and LHM appear to have similar perioperative outcomes. Further investigation is needed regarding long-term results after POEM.
背景
经口内镜下肌切开术（POEM）是一种治疗贲门失弛缓症的新型内镜手术。POEM 的手术结果数据较少，且尚无研究将 POEM 与手术标准——腹腔镜 Heller 肌切开术（LHM）进行比较。
方法
采用非随机方式比较 POEM 和 LHM 两组患者的围手术期结果。两组患者均符合以下纳入标准：贲门失弛缓症的诊断、年龄 18-85 岁、无既往贲门失弛缓症治疗史。
结果
18 例患者接受了 POEM，55 例患者接受了 LHM。POEM 的手术时间更短（113 分钟比 125 分钟，p<0.05），估计出血量更少（所有病例均为≤10 毫升，而 LHM 为 50 毫升，p<0.001）。肌切开长度、并发症发生率和住院时间相似。麻醉后护理病房到达时和术后第 1 天的疼痛评分相似，但 POEM 患者在术后 2 小时的疼痛评分更高（3.5 分比 2 分，p=0.03）。尽管 POEM 患者接受的酮咯酸较少，但两者的镇痛需求相似。POEM 患者的 Eckardt 评分降低（术后中位数为 1 分，术前中位数为 7 分，p<0.001），16 例（89%）患者在术后 6 个月的中位随访时获得了治疗成功（评分≤3）。POEM 术后 6 周，常规随访测压和食管造影显示食管胃结合部压力和对比柱高度恢复正常。
结论
POEM 和 LHM 的围手术期结果似乎相似。POEM 后的长期结果还需要进一步研究。
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