摘要
目的探讨经口内镜下肌切开术（POEM）与球囊扩张治疗对贲门失弛缓症患者的短期疗效差异。方法采用回顾性研究的方法，纳入2010年9月至2015年3月行POEM或球囊扩张的患者，分为POEM组26例和球囊扩张组40例。分别比较POEM和球囊扩张治疗前及治疗后1个月食管高分辨率测压参数，并对比治疗前及治疗后3个月内组间Eckardt评分（Eckardt评分≤3分为治疗成功的标准），以及胃食管反流症状。同组治疗前后比较采用Wilcoxon符号秩和检验；两组间比较采用Mann-Whitney U检验。率的比较采用Fisher确切概率法。结果POEM术后第1和3个月后治疗成功率分别为92.3%（24/26）和96.2%（25/26），球囊扩张术后第1和3个月后治疗成功率分别为87.5%（35/40）和75.0%（30/40）。治疗后3个月，POEM组治疗成功率高于球囊扩张组（Fisher确切概率法，P＝0.020）。治疗后3个月，POEM组Eckardt评分低于球囊扩张组[1.35（0，4.00）比2.73（0，6.00），U＝－3.921，P〈0.01]。第3个月末，POEM组患者胃食管反流发生率高于球囊扩张组[26.9%（7/26）比5.0%（2/40）, Fisher确切概率法，P＝0.010]。治疗后1个月，POEM组4s-IRP和LESP均低于球囊扩张组[7.01 mmHg（3.48 mmHg, 10.40 mmHg）比10.11 mmHg（5.75 mmHg, 12.91 mmHg）, U＝－4.541，P〈0.01；11.61 mmHg（4.21 mmHg, 14.64 mmHg）比17.85 mmHg（8.39 mmHg, 24.57 mmHg）, U＝－6.142，P〈0.01]。对贲门失弛缓症亚型分析表明，无论在Ⅰ型还是Ⅱ型贲门失弛缓症患者中，POEM疗效均优于球囊扩张。结论短期随访发现贲门失弛缓症患者中POEM疗效优于球囊扩张，但POEM术后胃食管反流发生率更高。
Objective To explore the difference in short-term efficacy between peroral endoscopic myotomy （POEM） and pneumatic dilatation （PD） in achalasia patients. Methods A retrospective analysis was applied. From September 2010 to March 2015, patients with POEM or PD were enrolled and divided into POEM group （n= 26） and PD group （n= 40）. High-resolution manometry （HRM） before and one month after treatment were compared between POEM group and PD group. Before and three months after treatment, Eekardt score and gastroesophageal reflux symptom was compared between groups （Eckardt score ^-~ 3 as the standard for successful treatment）. Wilcoxon signed rank test was performed for before and after treatment comparison in the same group. Mann-Whitney U test was used to compare between two groups and Fisher% exact test was used for rate comparison. Results The successful treatment rates at one and three month after POEM group were 92.3%（24/26） and 96.2~ （25/26）, respectively. The successful treatment rates at one and three month after PD were 87. 5%（35/40） and 75.0% （30/40）. At three month after treatment, the successful treatment rate of POEM group was higher than that of PD group （Fisberrs exact test, P=0. 02）. At three months after treatment, the Eckardt score of POEM group was lower than that of PD group （1.35, 0 to 4.00,vs 2.73, 0 to 6. 00; U=-3. 921, P〈0. 01）. By the end of three months after treatment, the rate of gastroesophageal reflux symptom of POEM group was higher than that of PD group （7/26, 26.9 % vs 2/40, 5.0 % ; Fisher＇s exact test, P = 0.01）. The postoperative 4 second integrated relaxation pressure （4s-IRP） and lower esophageal sphincter pressure （LESP） of POEM group were both lower than those of PD group （7. 01 mmHg, 3.48 to 10. 40 mmHg vs 10. 11 mmHg, 5. 75 to 12. 91 mmHg, U=-4. 541,P〈0. 01;11.61 mmHg, 4.21 to 14. 64 mmHg vs 17. 85 mmHg, 8. 39 to 24. 57 mmHg, U=-6.142,P〈0. 01）. The analysis of achalasia subtypes indicated that the efficacy of POEM was better than that of PD both in type I and type II. Conclusion During short-term follow-up, the efficacy of POEM was better than that of PD in achalasia patients, however there was a higher incidence of post-operative gastroesophageal reflux after POEM.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2016年第9期577-581,共5页
Chinese Journal of Digestion
基金
国家自然科学基金面上项目（81370492）
