Zhang Huahui, Wang Kuangjing, Fang Ying, Xiong Zhe, Lin Min, Jiang Lifeng, Niu Qiuya, Huang Jin
Graduate School of Dalian Medical University, Dalian, China.
Department of Gastroenterology, The People's Hospital of Ma'anshan, Ma'anshan, China.
Gastroenterol Res Pract. 2022 Mar 25;2022:3424470. doi: 10.1155/2022/3424470. eCollection 2022.
This retrospective study is aimed at evaluating the outcomes of a modified peroral endoscopic myotomy (POEM) technique in patients with type II achalasia.
We performed a modified POEM procedure, which involved a shorter (total myotomy length = 4 cm), full-thickness myotomy, on 31 patients with type II achalasia. Clinical success rates, technical success rates, pre- and postoperative esophageal manometry results, complications, and reflux-related adverse events were evaluated.
The clinical success (Eckardt score ≤ 3) rates were 100% and 88.9% within 2 years and beyond 2 years postoperatively, respectively. The median lower esophageal sphincter pressures (LESP) decreased from 31.6 (26.7-49.7) mmHg preoperatively to 13.4 (10.5-21.6) and 11.8 (7.4-16.7) mmHg ( < 0.001) at 6 and 12 months postoperatively, respectively. The median integrated relaxation pressure (IRP) decreased from 27.8 (20.6-37.5) mmHg preoperatively to 12.9 (11.3-23.4) and 11.6 (9.6-16.8) mmHg ( < 0.001) at 6 and 12 months after POEM, respectively. Only one case (3.2%) of mucosal injury, four (12.9%) cases of reflux esophagitis, and two (6.5%) cases of gastroesophageal reflux symptoms were reported.
The modified POEM technique showed excellent outcomes in patients with type II achalasia.
本回顾性研究旨在评估改良经口内镜下肌切开术（POEM）治疗Ⅱ型贲门失弛缓症患者的疗效。
我们对31例Ⅱ型贲门失弛缓症患者实施了改良POEM手术，该手术包括较短（总肌切开长度=4厘米）的全层肌切开术。评估临床成功率、技术成功率、术前和术后食管测压结果、并发症以及反流相关不良事件。
术后2年内和2年以上的临床成功率（ Eckardt评分≤3）分别为100%和88.9%。食管下括约肌压力（LESP）中位数术前为31.6（26.7 - 49.7）mmHg，术后6个月和12个月分别降至13.4（10.5 - 21.6）mmHg和11.8（7.4 - 16.7）mmHg（<0.001）。综合松弛压（IRP）中位数术前为27.8（20.6 - 37.5）mmHg，POEM术后6个月和12个月分别降至12.9（11.3 - 23.4）mmHg和11.6（9.6 - 16.8）mmHg（<0.001）。仅报告1例（3.2%）黏膜损伤、4例（12.9%）反流性食管炎和2例（6.5%）胃食管反流症状。
改良POEM技术在Ⅱ型贲门失弛缓症患者中显示出优异的疗效。
Zotero 插件