浅谈经黏膜下隧道内镜肌切开术适应证

Indication of submucosal tunneling endoscopic myotome

摘要:

经黏膜下隧道内镜肌切开术（submucosal tunneling endoscopic myotomy, STEM）是经自然腔道内镜手术（natural orifice transluminal endoscopic surgery, NOTES）的分支，包括经口和经直肠两种途径，即为经口内镜下肌切开术（peroral endoscopic myotomy, POEM）和经直肠内镜下肌切开术（per rectal endoscopic myotomy, PREM）。2007年 Pasricha等首次用动物模型证实POEM治疗贲门失弛缓症（achalasia, AC）的可行性， 2010年Inoue等率先将其用于AC临床治疗并取得了满意疗效。随后国内外陆续有临床研究证实POEM治疗AC的疗效及安全性，目前全球已有逾5000例AC患者接受POEM治疗。随着STEM技术的不断改良，其适应症也不断拓宽，现就STEM适应症做一述评。

Abstract:

Submucosal tunneling endoscopic myotomy is a branch of natural orifice transluminal endoscopic surgery, which include peroral endoscopic myotomy (POEM）and（per rectal endoscopic myotomy, PREM). POEM was first described by Pasricha et al in an animal achalasia model, and the introduced into clinical use by Inoue et al in 2010, which lead to a satisfactory efficacy. Then more and more studies have demonstrated the safety and efficacy of POEM for treating achlasia, and more than 5000 achalasia patients have received POEM therapy all around the world. With the development of STEM， its indications expended. In the present comment, we review the indication of STEM.