经口内镜下肌切开术是治疗贲门失弛缓症合并食管裂孔疝的有效方法。
Peroral endoscopic myotomy is an effective treatment for achalasia combined with hiatal hernia.
机构信息
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.
出版信息
Surg Endosc. 2024 Aug;38(8):4543-4549. doi: 10.1007/s00464-024-10948-y. Epub 2024 Jun 27.
PURPOSE
To explore the feasibility of peroral endoscopic myotomy (POEM) in patients with achalasia and hiatal hernia.
MATERIALS AND METHODS
We performed a retrospective review of 2136 patients with achalasia between January 2016 and December 2022. Patients with achalasia and hiatal hernia were assigned into study group, and matched patients with achalasia but no hiatal hernia were assigned into control group. The preoperative baseline information, procedure-related adverse events (AEs) and follow-up data were compared between the two groups.
RESULTS
Hiatal hernia was identified in 56/1564 (3.6%) patients with achalasia. All of these patients underwent POEM with success. The preoperative baseline characteristics were similar between the study and control group. The study group presented with a similar rate of mucosal injury (12.5% vs 16.1, P = 0.589), pneumothorax (3.6% vs 1.8%, P = 1.000), pleural effusion (8.9% vs 12.5%, P = 0.541) and major AEs (1.8% vs 1.8%, P = 1.000) compared with the control group. As for the follow-up data, no significant differences were observed in clinical success (96.4% vs 92.9%, P = 0.679; 93.6% vs 94.0%, P = 1.000; 86.5% vs 91.4%, P = 0.711) clinical reflux (25.0% vs 19.6%, P = 0.496; 31.9% vs 26.0%, P = 0.521; 35.1% vs 31.4%, P = 0.739) and proton pump inhibitor usage (17.9% vs 16.1%, P = 0.801; 29.8% vs 24.0%, P = 0.520; 32.4% vs 25.7%, P = 0.531) between the study group and control group at 1-year, 2-year and 3-year follow-ups.
CONCLUSIONS
POEM is a safe and effective treatment for achalasia combined with hiatal hernia.
目的
探讨经口内镜肌切开术（POEM）治疗贲门失弛缓症合并食管裂孔疝的可行性。
材料与方法
我们回顾性分析了 2016 年 1 月至 2022 年 12 月期间 2136 例贲门失弛缓症患者的临床资料。将贲门失弛缓症合并食管裂孔疝的患者归入研究组，将贲门失弛缓症但无食管裂孔疝的患者归入对照组。比较两组患者的术前基线资料、手术相关不良事件（AE）及随访资料。
结果
56/1564（3.6%）例贲门失弛缓症患者合并食管裂孔疝。所有患者均成功行 POEM 治疗。研究组和对照组的术前基线特征相似。研究组黏膜损伤发生率（12.5% vs 16.1%，P=0.589）、气胸发生率（3.6% vs 1.8%，P=1.000）、胸腔积液发生率（8.9% vs 12.5%，P=0.541）和主要 AE 发生率（1.8% vs 1.8%，P=1.000）与对照组相似。随访资料显示，两组临床成功率（96.4% vs 92.9%，P=0.679；93.6% vs 94.0%，P=1.000；86.5% vs 91.4%，P=0.711）、临床反流发生率（25.0% vs 19.6%，P=0.496；31.9% vs 26.0%，P=0.521；35.1% vs 31.4%，P=0.739）和质子泵抑制剂使用率（17.9% vs 16.1%，P=0.801；29.8% vs 24.0%，P=0.520；32.4% vs 25.7%，P=0.531）在术后 1 年、2 年和 3 年均无显著差异。
结论
POEM 是治疗贲门失弛缓症合并食管裂孔疝的一种安全有效的方法。
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