POEM治疗28例贲门失弛缓症患者的远期疗效分析

Peroral endoscopic myotomy for treatment of 28 achalasia patients: analysis of the long-term efficiency and related complications

关键词:  贲门失弛缓症  经口内镜肌切开术（POEM）  预后

Key words:  achalasia  peroral endoscopic myotomy（POEM）  prognosis

摘要:

目的　分析贲门失弛缓症(achalasia，AC)经口内镜下肌切开术（peroral endoscopic myotomy,POEM）治疗后的远期疗效，及术后并发反流的情况。方法　对28例AC患者行POEM术，术前及术后随访时行Eckardt评分，健康调查问卷SF-36，食道测压观察术后疗效;随访时行RDQ量表，胃镜及24 h食道pH值监测观察有无胃食管反流。结果　治疗有效27例（96.4%)。术后Eckardt评分、健康调查问卷SF-36均较术前改善（P<0.001)。28例患者经RDQ量表评分诊断有反流症状4例。随访时有14例行胃镜检查，诊断食道炎5例。有4例患者行食道24h pH值监测，诊断2例患者有酸反流，其中1例有反流症状，另1例无反流症状。结论　AC患者POEM术后1年以上的疗效较好，临床症状、生活质量、食管动力均得到明显改善。POEM术后远期可能并发胃食管反流，无反流症状的AC患者也有发生病理性反流可能。

Abstract:

Objective　To assess the long-term efficacy of peroral endoscopic myotomy (POEM) for treatment of achalasia (AC) and to evaluate the incidence of postoperative gastroesophageal reflux. 　Methods　Eckardt score, SF-36 health questionnaire and esophageal manometry were used to evaluate the efficacy of POEM in 28 AC patients. RDQ was tested for all patients, gastroscopy and 24-hour esophageal pH monitoring for part of the patients, to evaluate gastroesophageal reflux disease. 　Results　Twenty seven patients were treated by POEM successfully. The postoperative Eckardt score and SF-36 score were significantly improved(P<0.001). All 28 patients were followed up and 4 patients were diagnosed with reflux according to RDQ. Gastroscopy was performed in 14 patients and revealed esophagitis in 5 patients（2 patients had reflux symptoms simultaneously). Four patients underwent esophageal 24 hours PH monitoring, which showed that 2 patients had reflux, including one with reflux symptoms and the other one without symptoms. 　Conclusion　The therapeutic efficacy is excellent one year after POEM with significantly improved clinical symptoms, life quality and esophageal motility. POEM could cause postoperative gastroesophageal reflux disease. Some patients may develop pathological reflux without clinical symptoms.