摘要
目的比较经口内镜下食管环形肌切开术（POEM）与经左胸行食管下段贲门肌层切开术治疗贲门失弛缓症的疗效与安全性.方法66例贲门失弛缓症患者,37例接受POEM术治疗,29例接受传统开胸手术治疗,回顾分析比较POEM术与传统开胸手术治疗贲门失弛缓症二种方法的疗效、并发症、住院时间、复发率、安全性.结果术后发生并发症POEM组6例（发生率16.2%,包括纵隔及皮下气肿4例,肺部感染1例,消化道出血1例）,传统手术组5例（发生率17.2%,包括肺部感染2例、胸腔积液1例、皮下及阴囊气肿1例、消化道出血1例）,差异无统计学意义;术后住院天数POEM组（5.22±1.45）d,传统手术组（7.48±0.87）d,差异有统计学意义;术后复发POEM组2例（5.4%,对复发患者再次行POEM术,仍有效）,传统手术组无一例复发.结论与传统开胸手术相比,POEM术能获得同样的临床疗效,且具有微创、恢复快、住院时间短、并发症轻等优点,操作相对简便,耐受性好,风险小,可作为贲门失弛缓症治疗方法的首选;POEM术虽然存在一定的复发率,但仍可通过再次POEM术治疗等补救.
Objective To compare the efficacy and safety of peroral endoscopic myotomy（POEM）with surgical therapy in the treatment of esophageal achalasia. Methods The patients diagnosed as esophageal achalasia in the First Affliated Hospital of Soochow University from January 2010 to September 2012 were collected,who were treated by POEM or surgery .The efficacy,complication,length of stay,relapse rate,safety were analysed among the two groups. Results Sixty six patients met the requirement.There were 37 patients in the POEM group,29 patients in the surgery group.Six patients in the POEM group occurred complications,four of them complicated with emphysema of mediastina and subcutaneous tissue, one of them complicated with pulmonary inflammation,one of them complicated with gastrointestinal bleeding,the rate of complication occurrence was 16.2%.Five patients in the surgery group occurred complications,two of them complicated with pulmonary inflammation,one of them complicated with pleural effusion,one of them complicated with emphysema of scrotum and subcutaneous tissue,one of them complicated with gastrointestinal bleeding,the rate of complication occurrence was 17.2%.By chi-square test,there was no statistical difference in the rate of complication occurrence between the two groups.The postoperative hospital stay in the POEM group was 5.22±1.45 days,and in the surgery group was 7.48±0.87 days（P〈0.01）, there was statistical difference between the two groups.Two patients in the POEM group relapsed,the rate of relapse was 5.4%.The curative effect to the relapsed patients retreated by POEM was still obvious.No one relapsed in the surgery group. Conclusions Compared with the surgery group,the POEM group has the similar curative effect in treatment of esophageal achalasia.Owing to its benefits of mini-invasive treatment,quick recovery,short hospitalization,mild complicaions,simlpe, convenient,well tolerated,low risk,POEM is the first choice in treating esophageal achalasia recently.In spite of its relapse, it still can be remedied well by retreatment of POEM.
出处
《浙江临床医学》
2013年第4期447-449,共3页
Zhejiang Clinical Medical Journal
关键词
贲门失弛缓症
POEM术
外科手术
Esophageal achalasia Peroral endoscopic myotomy Surgery
