University of Medicine and Pharmacy Iuliu Hatieganu, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Cluj Napoca, Romania.
J Gastrointestin Liver Dis. 2013 Dec;22(4):461-3.
Traditional endoscopic treatment of achalasia consists of endoscopic balloon dilatation with the inconvenience of the recurrence of symptoms and the necessity of repeated sessions. Surgical laparoscopic procedure has been advocated to be more efficient especially in young patients because it sections the lower oesophageal sphincter via a transabdominal approach. The long term most severe complication has been refractory reflux oesophagitis due mainly to the alteration of the oesogastric antireflux anatomy (Hiss angle). Surgical myotomy was clasically associated with an antireflux procedure. Peroral endoscopic myotomy (POEM) via a mucosal orifice is as efficient as surgical myotomy but the antireflux anatomy of gastroesophageal junction is not altered, so the reflux symptoms are reduced. Second, POEM is mini invasive in comparison with laparoscopic surgery. The paper presents our first and successful case of this endoscopic surgical procedure in a 41 year old patient.
传统的内镜治疗贲门失弛缓症包括内镜球囊扩张，但存在症状复发的不便和需要多次治疗的问题。腹腔镜手术已被提倡用于治疗，尤其是在年轻患者中，因为它通过经腹途径来切开食管下括约肌。长期来看，最严重的并发症是难治性反流性食管炎，主要是由于食管胃抗反流解剖结构（His 角）的改变。传统上，外科肌切开术与抗反流手术相关联。经口内镜肌切开术（POEM）通过黏膜口进行，与外科肌切开术一样有效，但胃食管交界处的抗反流解剖结构没有改变，因此反流症状减少。其次，与腹腔镜手术相比，POEM 是一种微创的手术。本文介绍了我们在一名 41 岁患者中进行的首例成功的内镜手术案例。
