经口内镜下环形肌切开术治疗老年贲门失弛缓症的疗效

Effects of peroral endoscopic myotomy on achalasia in geriatric patients

摘要:

目的 探索经口内镜下环形肌切开术（POEM）治疗老年贲门失弛缓症（AC）的安全性、可行性、围手术期及远期疗效。 方法 回顾性分析2010年8月至2014年12月期间在复旦大学附属中山医院确诊为AC并接受POEM治疗、可获得完整随访资料的老年（≥65岁）患者共41例，观察手术相关并发症、治疗前后Eckardt评分及食管下段括约肌压力变化，并分析远期食管反流及治疗失败的发生情况。 结果 41例患者均成功完成POEM手术，中位手术时间42 min，中位住院天数为3 d，共4例（975%）患者出现主要围手术期不良事件，均为因围手术期不良事件导致住院时间长于5 d。中位随访时间40个月（四分位数区间 24~57个月），Eckardt评分中位数从术前8分下降为术后1分（P<0001），食管下段括约肌压力中位数从术前2385 mmHg (1 mmHg=0133 kPa) 下降为术后905 mmHg (P=0005)。术后随访12例（2927%）患者出现临床反流，5年临床治疗成功率8780%(36/41)。 结论 POEM治疗老年AC患者安全可靠，近期和远期疗效均较好。

Abstract:

Objective To evaluate the safety, feasibility, perioperative and long-term efficacy of peroral endoscopic myotomy (POEM) for achalasia (AC) in geriatric patients. Methods Data of 41 patients aged over 65 diagnosed with achalasia and treated with POEM in Zhongshan Hospital from August 2010 to December 2014 were retrospectively studied. Perioperative complications, preoperative and postoperative Eckardt score and pressure of the lower esophageal sphincter, esophageal reflux and clinical failure were analyzed. Results All 41 patients underwent POEM successfully, with median operation time of 42 min. Median hospitalization was 3 days. Major perioperative adverse events occurred in 4 cases (975%), whose hospitalization was longer than 5 days for perioperative adverse events. During median follow-up period of 40 months (interquartile range 24-57 months), median Eckardt score decreased from 8 to 1（P<0001）and pressure of the lower esophageal sphincter decreased from 2385 mmHg(1 mmHg=0133 kPa) to 905 mmHg (P=0005). Clinical reflux occurred in 12 cases (2927%) and the 5-year success rate of POEM was 8780% (36/41). Conclusion POEM is a safe and reliable treatment for geriatric AC patients with confirmed short-term and long-term effectiveness.