分段式经口内镜食管下括约肌切开术治疗贲门失弛缓症的临床疗效初探

Clinical efficacy of segmented peroral endoscopic myotomy for the treatment of achalasia

摘要:

探讨改良的分段式经口内镜食管下括约肌切开术（peroral endoscopic myotomy，POEM）治疗贲门失弛缓症（achalasia，AC）的临床效果，纳入2019年12月至2021年12月建湖县人民医院收治的AC患者进行回顾性队列研究，其中采用分段式POEM治疗的患者纳入分段式POEM组，采用渐进式POEM治疗的患者纳入渐进式POEM组，比较两组患者的围手术期指标（术前及术后6个月时的Eckardt评分）、临床疗效及并发症发生情况。共纳入65例患者，其中分段式POEM组28例，渐进式POEM组37例。两组患者的一般资料，包括性别、年龄、病变分型、术前Eckardt评分比较差异无统计学意义（P>0.05）。术后并发症方面，两组皮下气肿发生率［3.6%（1/28）比24.3%（9/37），P=0.035］和少量胸腔积液发生率［7.1%（2/28）比27.0%（10/37），χ2=4.186，P=0.041］比较差异有统计学意义；术后胸痛持续时间［（36.5±10.5）h比（44.3±11.8）h，t=2.765，P=0.008］和疼痛程度（4.1±2.1比6.2±2.3，t=3.783，P<0.001），以及发热天数［（2.1±1.3）d比（3.1±1.5）d，t=2.816，P=0.007］比较差异也均有统计学意义；两组患者术后气胸发生率比较差异无统计学意义［0.0%（0/28）比2.7%（1/37），P=1.000］。术后随访6个月，分段式POEM组患者胸骨后疼痛、胃食管反流发生率低于渐进式POEM组（P<0.05），Eckardt评分［（2.2±1.1）分比（2.9±1.3）分，t=2.294，P=0.025］有明显改善。分段式POEM与渐进式POEM均可有效治疗AC，但分段式POEM安全性更高，术后胸痛、胃食管反流并发症发生率更低，临床疗效更好。

Abstract:

To explore the clinical efficacy of the modified segmented peroral endoscopic myotomy (POEM) for the treatment of achalasia (AC), AC patients admitted to the Jianhu People""s Hospital from December 2019 to December 2021 were included in a retrospective cohort study. Patients received segmented POEM were included in the segmented POEM group, while patients treated with progressive POEM were included in the progressive POEM group. Perioperative indicators (including Eckardt scores preoperatively and at 6 months postoperatively), clinical efficacy, and complications were compared between the two groups. A total of 65 AC patients were included, among them, 28 patients were in the segmented POEM group, and 37 patients in the progressive POEM group. There were no significant differences in the general information of the two groups, including gender, age, lesion type, or Eckardt scores before the operation (P>0.05). There were significant differences in the incidence of postoperative complications, including subcutaneous emphysema [3.6% (1/28) VS 24.3% (9/37), P=0.035] and small pleural effusion [7.1% (2/28) VS 27.0% (10/37), χ2=4.186, P=0.041] between the two groups. Postoperative chest pain duration (36.5±10.5 hours VS 44.3±11.8 hours, t=2.765, P=0.008), severity (4.1±2.1 VS 6.2±2.3, t=3.783, P<0.001), and fever days (2.1±1.3 days VS 3.1±1.5 days, t=2.816, P=0.007) also showed statistical difference. However, there was no significant difference in the incidence of postoperative pneumothorax between the two groups [0.0% (0/28) VS 2.7% (1/37), P=1.000]. At the 6-month follow-up, the segmented POEM group had a lower incidence of retrosternal pain and gastroesophageal reflux compared to the progressive POEM group (P<0.05), and the Eckardt score was significantly improved (2.2±1.1 VS 2.9±1.3, t=2.294, P=0.025). Both segmented and progressive POEM are effective treatments for AC, but segmented POEM has higher safety, lower incidence of postoperative chest pain and gastroesophageal reflux complications, and better clinical efficacy.