经口内镜全层肌切开术治疗重症贲门失弛缓症的临床应用

目的探讨经口内镜全层肌切开术治疗重症贲门失弛缓症的疗效与安全性。方法经口内镜全层肌切开术治疗64例重症（至少满足以下条件之一：Eckardt评分≥6分；食管直径≥6cm或S形食管）贲门失弛缓症患者，术后定期随访和复查，收集患者一般情况、症状评分、并发症、复发、内镜及X线钡餐检查结果等资料。结果64例患者均成功完成手术，平均操作时间55min，隧道长度平均14．1cm，肌切开长度平均10．6cm，全层肌切开范围为食管胃接合部上下6．0cm。术后患者症状均得到缓解；并发症发生率为9．4％（6／64），其中气肿发生率为6．3％（4／64）。术后6个月，Eckardt评分较术前明显改善（7．4±1．5）分比（0．6±0．8）分，P〈0．001]，食管直径较术前明显减小（59．7±13．0）mm比（31．4±3．3）mm，P〈0．001]，贲门口直径较术前明显扩大（15．6±10．1）mm比（33．4±8．9）mm，P〈0．01]。平均随访12．3个月，98．4％（63／64）有效；随访期内无复发病例。结论经口内镜下全层肌切开术可作为重症贲门失弛缓症患者的有效治疗手段，但临床应用时间尚短，其长期疗效及远期并发症仍有待于进一步随访评估。

Peroral endoscopic full-thickness myotomy for severe esophageal achalasia

Objective To evaluate the efficacy and safety of peroral endoscopic full-thickness myoto- my for patients with severe esophageal achalasia. Methods A total of 64 patients with severe achalasia, whose Eckardt＇s score ≥6, esophageal diameter ≥6 cm or with S-type esophagus, were treated by peroral endoscopic full-thickness myotomy. Data of Eckardt＇s score, complications, recurrence, gastroscopy and esophageal barium radiography were collected before and during periodical follow-up. Results All the 64 patients underwent peroral endoscopic myotomy （POEM） successfully, mean operation time was 55 minutes, average length of tunnel and myotomy were 14. 1 cm and 10. 6 cm respectively, and full-thickness myotomy was performed beyond 6 cm near esophagogastric junction. Symptoms remitted in all patients. Eckardt＇s score decreased significantly pre-treatment VS post-treatment, （7.4 ± 1.5 ） VS （0. 6 ± 0. 8）, P 〈 0. 001 ], the diameter of esophageal lumen reduced pre-treatment VS post-treatment, （59.7 ± 13.0） mm VS （31.4 ±3.3） mm, P 〈 0. 001 ）, and the diameter of cardia increased pre-treatment VS post-treatment, （ 15.6 ± 10. 1 ）mm VS （33.4 ±8.9）mm, P 〈0. 001 ]. Complications occurred in 9. 4% （6/64） of the cases, gas-related complications was 6. 3% （4/64）. Treatment success was achieved in 98.4% cases （63/64） with a follow-up of 6-20 months （median 12. 3 months） , with no recurrence cases. Conchlsion Peroral endoscopic full-thickness myotomy is an effective and safe method for severe achalasia. Long-term efficacy and complications need further assessment.