J Gastrointest Surg. 2014 Jun;18(6):1071-6. doi: 10.1007/s11605-014-2496-2.
The purpose of this study was to demonstrate the feasibility of performing peroral endoscopic myotomy (POEM) in the management of recurrent achalasia after failed myotomy.
Eight patients presented to our institution between October 2010 and June 2013 with recurrent/persistent symptoms after prior laparoscopic Heller myotomy. Three patients underwent redo laparoscopic Heller myotomy, and five patients consented to redo myotomy with POEM.
Demographics were similar between the groups with exception of age (POEM 69.5 vs. laparoscopic Heller myotomy (LHM) 34.5, p = 0.003). Preoperative Eckardt scores, motility, and prior interventions were not significantly different. Three patients who underwent POEM and two who underwent laparoscopic Heller myotomy had prior fundoplication. There was one perforation identified after laparoscopic Heller myotomy and one patient with persistent subcutaneous emphysema after POEM. Both POEM and laparoscopic Heller myotomy demonstrated significant improvement in symptoms and Eckardt scores at average follow-up of approximately 5 months (p < 0.05).
POEM is a feasible option for patients after failed myotomy even in the presence of prior fundoplication. The procedure can be performed safely using a similar technique as for primary myotomy with the exception of creating the myotomy laterally along the right side of the esophagus and lesser curvature avoiding the previous anterior myotomy.
本研究旨在展示经口内镜肌切开术（POEM）在治疗先前肌切开术失败后的复发性贲门失弛缓症中的可行性。
2010 年 10 月至 2013 年 6 月期间，有 8 例患者因先前腹腔镜 Heller 肌切开术失败后出现复发/持续性症状而就诊于我院。其中 3 例患者接受了再次腹腔镜 Heller 肌切开术，5 例患者同意再次进行 POEM 肌切开术。
两组患者的人口统计学特征相似，除年龄外（POEM 组 69.5 岁，腹腔镜 Heller 肌切开术组 34.5 岁，p=0.003）。术前 Eckardt 评分、动力和先前干预措施无显著差异。接受 POEM 的 3 例患者和接受腹腔镜 Heller 肌切开术的 2 例患者均有先前的胃底折叠术。腹腔镜 Heller 肌切开术后发现 1 例穿孔，POEM 后发现 1 例持续皮下气肿。POEM 和腹腔镜 Heller 肌切开术在平均约 5 个月的随访中均显著改善了症状和 Eckardt 评分（p<0.05）。
即使存在先前的胃底折叠术，POEM 也是治疗肌切开术失败后患者的可行选择。该手术可以使用与原发性肌切开术类似的技术安全进行，除了在食管右侧和小弯侧沿侧向创建肌切开术，避免先前的前侧肌切开术。
