Wei Mingtian, Yang Tinghan, Yang Xuyang, Wang Ziqiang, Zhou Zongguang
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, Sichuan Province, China .
J Laparoendosc Adv Surg Tech A. 2015 Feb;25(2):123-9. doi: 10.1089/lap.2014.0454.
This meta-analysis aims to add convincing evidence on the application of peroral esophageal myotomy (POEM), compared with laparoscopic Heller's myotomy (LHM), for the treatment of achalasia.
The electronic databases of PubMed, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Embase (up to December 2013) were systematically searched. EndNote(®) X6 citation software (Thomson Reuters, New York, NY) was used for literature management. A modification of the Newcastle-Ottawa Scale was applied for quality assessment. The data were analyzed using Review Manager version 5.1 software (The Cochrane Collaboration, Oxford, United Kingdom), and sensitivity analysis was performed by sequentially omitting each study.
Overall, four studies compared the outcomes between POEM and LHM. All studies were conducted in the United States and published in 2013. POEM was associated with comparable complications (odds ratio [OR]=1.17, 95% confidence interval [CI] 0.53-2.56, P=.70), gastroesophageal reflux (OR=1.00, 95% CI 0.38-2.61, P=1.00), and symptomatic recurrence by Eckardt score (OR=0.24, 95% CI 0.04-1.55, P=.13). Other outcomes including pain score, operating time, and hospital stay were assessed with no significant difference between POEM and LHM.
POEM achieves equivalent short-term outcomes compared with LHM for achalasia. This novel procedure is a promising treatment for achalasia.
本荟萃分析旨在为经口食管肌层切开术（POEM）与腹腔镜Heller肌层切开术（LHM）治疗贲门失弛缓症的应用提供有说服力的证据。
系统检索了PubMed、Cochrane对照试验中心注册库、Cochrane系统评价数据库和Embase（截至2013年12月）的电子数据库。使用EndNote® X6文献管理软件（汤森路透公司，纽约，纽约州）进行文献管理。采用纽卡斯尔-渥太华量表的修改版进行质量评估。使用Review Manager 5.1软件（Cochrane协作网，英国牛津）进行数据分析，并通过依次剔除每项研究进行敏感性分析。
总体而言，四项研究比较了POEM和LHM的治疗效果。所有研究均在美国进行，并于2013年发表。POEM的并发症发生率相当（优势比[OR]=1.17，95%置信区间[CI] 0.53 - 2.56，P = 0.70），胃食管反流发生率相当（OR = 1.00，95% CI 0.38 - 2.61，P = 1.00），根据Eckardt评分的症状复发率相当（OR = 0.24，95% CI 0.04 - 1.55，P = 0.13）。其他结果，包括疼痛评分、手术时间和住院时间，在POEM和LHM之间评估无显著差异。
对于贲门失弛缓症，POEM与LHM相比可获得相当的短期治疗效果。这种新手术是一种有前景的贲门失弛缓症治疗方法。
