≥65岁患者贲门失弛缓症的经口内镜下肌切开术
Peroral endoscopic myotomy for achalasia in patients aged ≥ 65 years.
作者信息
Li Chen-Jie, Tan Yu-Yong, Wang Xue-Hong, Liu De-Liang
机构信息
Chen-Jie Li, Yu-Yong Tan, Xue-Hong Wang, De-Liang Liu, Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.
出版信息
World J Gastroenterol. 2015 Aug 14;21(30):9175-81. doi: 10.3748/wjg.v21.i30.9175.
AIM
To investigate the safety and efficacy of peroral endoscopic myotomy (POEM) for achalasia in patients aged ≥ 65 years.
METHODS
From November 2011 to August 2014, 15 consecutive patients (aged ≥ 65 years) diagnosed with achalasia were prospectively recruited and all underwent POEM at our institution. Eckardt score, lower esophageal sphincter (LES) pressure, esophageal diameter, SF-36 questionnaire, and procedure-related complications were used to evaluate the outcomes.
RESULTS
All 15 patients were treated successfully by POEM, with a median operation time of 55 min. Median myotomy length was 10 cm. Three patients underwent circular myotomy and 12 full-thickness myotomies. Symptoms remitted in all cases during post-POEM follow-up of 6-39 mo. Eckardt score reduced significantly (pre-operation vs post-operation: 8.0 vs 1.0, P < 0.05). Median LES pressure decreased from 27.4 to 9.6 mmHg (P < 0.05). Median diameter of the esophagus was significantly decreased (pre-operation vs post-operation: 51.0 mm vs 30.0 mm, P < 0.05). Only one patient had reflux, which was resolved with oral proton pump inhibitors. No serious complications related to POEM were found. The quality of life of the 15 patients improved significantly after POEM.
CONCLUSION
POEM is a safe and effective technique for treatment of achalasia in patients aged ≥ 65 years, with improvement in symptoms and quality of life.
目的
探讨经口内镜下肌切开术（POEM）治疗65岁及以上贲门失弛缓症患者的安全性和有效性。
方法
2011年11月至2014年8月，前瞻性招募了15例连续诊断为贲门失弛缓症的患者（年龄≥65岁），所有患者均在本机构接受POEM治疗。采用埃卡德特评分、食管下括约肌（LES）压力、食管直径、SF-36问卷和与手术相关的并发症来评估治疗效果。
结果
15例患者均成功接受POEM治疗，中位手术时间为55分钟。中位肌切开长度为10厘米。3例行环形肌切开术，12例行全层肌切开术。在POEM术后6 - 39个月的随访中，所有病例症状均缓解。埃卡德特评分显著降低（术前vs术后：8.0 vs 1.0，P < 0.05）。LES压力中位数从27.4降至9.6 mmHg（P < 0.05）。食管直径中位数显著减小（术前vs术后：51.0 mm vs 30.0 mm，P < 0.05）。仅1例患者出现反流，口服质子泵抑制剂后得以解决。未发现与POEM相关的严重并发症。15例患者POEM术后生活质量显著改善。
结论
POEM是治疗65岁及以上贲门失弛缓症患者的一种安全有效的技术，可改善症状和生活质量。
Zotero 插件