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重度贲门失弛缓症患者经口内镜下全层肌切开术的回顾性研究

A Retrospective Study of Peroral Endoscopic Full-Thickness Myotomy in Patients with Severe Achalasia.

作者信息

Duan Tianying, Tan Yuyong, Zhou Junfeng, Lv Liang, Liu Deliang

机构信息

Department of Gastroenterology, The Second Xiangya Hospital, Central South University , Changsha, China .

出版信息

J Laparoendosc Adv Surg Tech A. 2017 Aug;27(8):770-776. doi: 10.1089/lap.2016.0445. Epub 2017 May 30.

Abstract

OBJECTIVES

Selective circular myotomy (CM) is recommended in peroral endoscopic myotomy (POEM) for achalasia, but completeness of myotmoy is the prerequisite for excellent long-term results of conventional surgical myotomy. The aim of our study was to compare the efficacy and safety between peroral endoscopic full-thickness and simple CM for the treatment of severe achalasia.

MATERIALS AND METHODS

A total of 123 severe achalasia patients who underwent POEM from August 2011 to May 2013 were included. They were divided into circular or full-thickness myotomy (FTM) groups according to the depth of myotomy. Demographics, Eckardt score, procedure-related parameters, perioperative adverse events, pre- and postoperative esophageal diameter, esophageal manometry, and follow-up results were retrospectively collected and compared between the two groups.

RESULTS

All the 123 patients underwent POEM successfully, and the mean operation time was significantly shorter in FTM group compared with CM group (57.4 ± 8.2 minutes versus 63.2 ± 12.3 minutes, P < .05). There was no significant difference between the two groups in terms of treatment success, pre- and postoperative Eckardt score, esophageal diameter, esophageal manometry, and perioperative adverse events (P > .05). Twenty-four-hour pH monitoring was performed in 19 patients (11 in FTM, 8 in CM). Although no statistical difference was detected in rate of abnormal esophageal acid exposure between groups, this rate was higher in FTM group than CM group (60% versus 40%, P > .05).

CONCLUSION

Treatment efficacy in short-to-medium term are comparable between circular or FTM. FTM significantly reduce the operative duration, but it may increase potential risk of gastroesophageal reflux disease incidence.

摘要

目的

在经口内镜下肌切开术(POEM)治疗贲门失弛缓症时推荐采用选择性环形肌切开术(CM),但肌切开的完整性是传统外科肌切开术获得优异长期疗效的前提条件。本研究的目的是比较经口内镜全层肌切开术与单纯CM治疗重度贲门失弛缓症的疗效和安全性。

材料与方法

纳入2011年8月至2013年5月期间接受POEM治疗的123例重度贲门失弛缓症患者。根据肌切开深度将他们分为环形或全层肌切开术(FTM)组。回顾性收集两组患者的人口统计学资料、埃卡德特评分、手术相关参数、围手术期不良事件、术前和术后食管直径、食管测压以及随访结果并进行比较。

结果

123例患者均成功接受了POEM治疗,FTM组的平均手术时间显著短于CM组(57.4±8.2分钟对63.2±12.3分钟,P<0.05)。两组在治疗成功率、术前和术后埃卡德特评分、食管直径、食管测压以及围手术期不良事件方面无显著差异(P>0.05)。对19例患者(FTM组11例,CM组8例)进行了24小时pH监测。虽然两组间食管酸暴露异常率未检测到统计学差异,但FTM组的该比率高于CM组(60%对40%,P>0.05)。

结论

环形或FTM在中短期的治疗疗效相当。FTM显著缩短了手术时间,但可能增加胃食管反流病发生的潜在风险。

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