Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Surgery. 2013 Oct;154(4):885-91; discussion 891-2. doi: 10.1016/j.surg.2013.04.051.
Peroral esophageal myotomy (POEM) differs from laparoscopic Heller myotomy (LHM) in that only the circular muscle layer of the esophagus is divided, the hiatus is not mobilized, and an antireflux procedure is not performed. The effect of these differences on anatomic and functional outcomes is unknown.
Patients who underwent LHM or POEM and had both a pre- and postoperative timed barium esophagogram were selected for analysis. Timed barium esophagograms were performed with 200 mL of contrast, with radiographs taken at 1, 2, and 5 minutes.
A total o f 17 LHM and 12 POEM patients had undergone pre- and postoperative timed barium esophagograms. Both groups had decreased column heights postoperatively at 1, 2, and 5 minutes (LHM: pre, 15.6, 12.7, 11.3 cm vs post, 3.6, 2.5, 1.8 cm; P < .001 and POEM: pre, 14.7, 11, 9.4 cm vs post, 4.4, 2.5, 1.2 cm; P < .001). There was no difference between procedures in changes from baseline column height. Both operations resulted in decreased esophageal width and less angulation between the esophageal body and esophagogastric junction.
POEM and LHM produce a similar short-term anatomic and functional result at the esophagogastric junction. POEM results in a similar narrowing and straightening of the esophagus despite the fact that POEM does not involve hiatal mobilization.
经口内镜下食管肌切开术（POEM）与腹腔镜 Heller 肌切开术（LHM）的不同之处在于，仅切开食管的环形肌层，不游离食管裂孔，也不进行抗反流手术。这些差异对解剖和功能结果的影响尚不清楚。
选择了接受 LHM 或 POEM 治疗且术前和术后均行定时钡餐食管造影检查的患者进行分析。用 200mL 造影剂进行定时钡餐食管造影，在 1、2 和 5 分钟时拍摄射线照片。
共 17 例 LHM 和 12 例 POEM 患者进行了术前和术后定时钡餐食管造影检查。两组患者术后 1、2 和 5 分钟的柱状高度均降低（LHM：术前 15.6、12.7、11.3cm 与术后 3.6、2.5、1.8cm；P<.001；POEM：术前 14.7、11、9.4cm 与术后 4.4、2.5、1.2cm；P<.001）。两种术式从基线柱状高度的变化无差异。两种手术均导致食管宽度减小，食管体与食管胃连接部之间的角度减小。
POEM 和 LHM 在食管胃连接部产生相似的短期解剖和功能结果。尽管 POEM 不涉及食管裂孔游离，但 POEM 也会导致食管狭窄和变直。
