[1]蒋彬,张灵敏,孙天宇,等.腹腔镜Heller手术与经口内镜下肌切开术治疗贲门失弛缓症的临床效果比较[J].第三军医大学学报,2019,41(22):2199-2204.
　JIANG Bin,ZHANG Lingmin,SUN Tianyu,et al.Laparoscopic Heller myotomy versus peroral endoscopic myotomy for achalasia: safety, efficacy and complications [J].J Third Mil Med Univ,2019,41(22):2199-2204.
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腹腔镜Heller手术与经口内镜下肌切开术治疗贲门失弛缓症的临床效果比较(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第22期
页码:
2199-2204
栏目:
临床医学
出版日期:
2019-11-30

文章信息/Info

Title:
Laparoscopic Heller myotomy versus peroral endoscopic myotomy for achalasia: safety, efficacy and complications
 
作者:
蒋彬; 张灵敏; 孙天宇; 谭群友; 王如文
陆军军医大学（第三军医大学）大坪医院全军胸外科研究所
Author(s):
JIANG Bin;  ZHANG Lingmin;  SUN Tianyu;  TAN Qunyou;  WANG Ruwen

Institute of Thoracic Surgery, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China

关键词:
贲门失弛缓症; 腹腔镜Heller肌切开术; 经口内镜下肌切开术; 胃食管反流病
Keywords:
achalasia;  laparoscopic Heller myotomy;  peroral endoscopic myotomy;  gastroesophageal reflux disease
分类号:
R181.31; R573.7; R656.61
文献标志码:
A
摘要:

目的 比较腹腔镜Heller手术（laparoscopic heller myotomy，LHM）和经口内镜下肌切开术（peroral endoscopic myotomy，POEM）治疗贲门失弛缓症的临床疗效，探讨POEM术后胃食管反流并发症的治疗策略。方法 采用回顾性队列研究的方法，收集2012年10月至2017年4月我院收治的61例贲门失弛缓症患者的临床资料，其中30例行腹腔镜Heller手术加部分胃底折叠术（Dor）为腹腔镜组（LHM组）；31例行经口内镜下肌切开术为内镜组（POEM组），随访至2019年4月，比较两组患者的基本资料、手术情况、临床疗效以及胃食管反流并发症（包括胃食管反流症状、病理性酸反流、食管炎）的情况。结果患者均顺利完成手术，无围术期死亡。LHM组和POEM组患者在手术时间、术中出血量、围术期并发症、平均住院日、住院费用等方面差异无统计学意义。LHM组和POEM组的治疗有效率分别为86.7%（26/30）和90.3%（28/31），差异无统计学意义。两组患者术后Ecardt评分、下段食管静息压较术前均明显下降（P<0.001），但两组之间比较，差异无统计学意义；POEM组术后胃食管反流症状（3/27 vs 11/20, P=0.018）、病理性酸反流（4/26 vs 12/18, P=0.024）、食管炎（2/28 vs 9/22, P=0.023）发生率显著高于LHM组。临床相关胃食管反流发生率在POEM组更高（1/29 vs 7/24, P=0.026）。结论 LHM与POEM治疗贲门失弛缓症的安全性及中远期疗效相近， 但是POEM手术缺乏抗反流措施，可导致胃食管反流发生率升高，术后应密切随访并积极干预。

Abstract:

Objective To compare the clinical efficacy of laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM) for treatment of achalasia, and investigate the strategy for management of gastroesophageal reflux disease (GERD) after POEM. MethodsThis retrospective cohort study was conducted among 61 patients undergoing minimally invasive surgery for achalasia in our hospital between October, 2012 and April, 2017. Of the 61 patients, 30 underwent LHM with Dor fundoplication (LHM group) and 31 underwent POEM. All patients were followed up to April, 2019. The general and perioperative data, clinical efficacy, and incidence of GERD complications (including GERD symptoms, pathological acid reflux and esophagitis) were compared between the 2 groups. ResultsThe operations were completed smoothly in all the patients without perioperative death. There were no significant differences between LHM and POEM groups in the operation time, intraoperative blood loss, perioperative complications, mean hospital stay or hospital costs. The 2 operations produced similar therapeutic effective rate [86.7% (26/30) vs 90.3%(28/31), P>0.05], and the Ecardt score and the lower esophageal sphincter pressure were decreased significantly in both groups after the operation (P<0.001), but there were no difference between the 2 operations. Compared with LHM, POEM was associated with significantly higher incidences of GERD symptoms (3/27 vs 11/20, P=0.018), pathological acid reflux (4/26 vs 12/18, P=0.024), and esophagitis (2/28 vs 9/22, P=0.023); the incidence of clinically relevant GERD was much higher in POEM group than in LHM group (1/29 vs 7/24, P=0.026). ConclusionLHM and POEM have similar safety and mid- and long-term efficacies for treatment of achalasia, but the absence of an antireflux wrap in POEM surgery leads to an increased risk of GERD. Patients planning to undergo POEM surgery should be closely followed after the surgery and given timely implementation of active interventions.

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更新日期/Last Update: 2019-11-21