内镜下肌切开不同术式治疗贲门失弛缓症的临床效果比较

Comparison of clinical outcomes among different endoscopic myotomy techniques for achalasia

摘要:

目的 比较经口内镜下肌切开术（peroral endoscopic myotomy，POEM）不同肌切开术式治疗贲门失弛缓症（achalasia，AC）的疗效及安全性。方法 回顾性分析2020年4月至2023年10月于北京协和医院诊断为AC并接受POEM治疗的患者资料，根据肌切开长度及厚度分为常规肌切开组、短肌切开组、全层肌切开组，分别比较常规肌切开组与短肌切开组、常规肌切开组与全层肌切开组之间操作时长、操作相关并发症、疗效、术后反流性食管炎发生率之间的差异。结果 总计纳入70例AC患者，其中常规肌切开组26例，短肌切开组19例，全层肌切开组25例。短肌切开组操作时长（72.89±20.57）min，显著低于常规肌切开组的（91.81±36.70）min（t=2.197，P=0.034），操作相关并发症发生率［26.3%（5/19）比34.6%（9/26），χ2=0.353，P=0.553］、治疗有效率［94.7%（18/19）比96.2%（25/26），χ2=0.052，P=0.820］、术后反流性食管炎发生率［50.0%（5/10）比41.7%（5/12），χ2=0.306，P=0.580］差异无统计学意义。常规肌切开组与全层肌切开组在操作时长［（99.64±29.13）min比（91.81±36.70）min，t=0.336，P=0.404］、操作相关并发症发生率［28.0%（7/25）比34.6%（9/26），χ2=0.259，P=0.611］、治疗有效率［96.0%（24/25）比96.2%（25/26），χ2=0.001，P=0.977］、术后反流性食管炎发生率［35.7%（5/14）比41.7%（5/12），χ2=0.022，P=0.883］方面差异均无统计学意义。结论 短肌切开POEM治疗AC较常规术式可得到相同效果，操作时长有所缩短，且不增加并发症发生率；采用全层肌切开术式较常规术式治疗效果、操作时长及并发症发生率大致相同。

Abstract:

Objective To compare the clinical efficacy and safety of different myotomy procedures during peroral endoscopic myotomy (POEM) for achalasia (AC). Methods A retrospective study was conducted involving patients diagnosed as having achalasia and underwent POEM at Peking Union Medical College Hospital from April 2020 to October 2023. Patients were divided into conventional myotomy group, short myotomy group and full-thickness myotomy group according to myotomy length and depth. Outcomes including operation duration, procedure-related complications, efficacy and incidence of postoperative reflux esophagitis were compared between conventional vs. short, and conventional vs. full-thickness groups. Results Among 70 patients, 26 underwent conventional myotomy, 19 short myotomy, and 25 full-thickness myotomy. The short myotomy group demonstrated significantly shorter procedure duration (72.89±20.57 min) compared to the conventional group (91.81±36.70 min, t=2.197, P=0.034). There were no statistically significant differences in procedure-related complications [26.3% (5/19) VS 34.6% (9/26), χ2=0.353, P=0.553], treatment efficacy [94.7% (18/19) VS 96.2% (25/26), χ2=0.052, P=0.820], or incidence of postoperative reflux esophagitis [50.0% (5/10) VS 41.7% (5/12), χ2=0.306, P=0.580] between the short and conventional myotomy groups. No statistically significant differences were observed between the conventional and full-thickness myotomy group in procedure duration (99.64±29.13 min VS 91.81±36.70 min, t=0.336, P=0.404), procedure-related complications [28.0% (7/25) VS 34.6% (9/26), χ2=0.259, P=0.611], treatment efficacy [96.0% (24/25) VS 96.2% (25/26), χ2=0.001, P=0.977], or incidence of postoperative reflux esophagitis [35.7% (5/14) VS 41.7% (5/12), χ2=0.022, P=0.883]. Conclusion Short myotomy POEM achieves comparable efficacy to conventional myotomy with reduced operative time and no increased complication risk. Full-thickness myotomy demonstrates similar efficacy, operative duration, and safety to conventional myotomy.