CAJ | 학술논문

背景：贲门失弛缓症的治疗目的为降低下食管括约肌压力（LESP），减轻梗阻，改善临床症状。经口内镜下肌切开术（POEM）近年来开始用于贲门失弛缓症的治疗。目的：通过分析手术前后食管动力的变化，评估 POEM治疗贲门失弛缓症的近期疗效。方法：纳入2011年12月～2012年10月在南京鼓楼医院诊断为贲门失弛缓症并接受POEM治疗的39例患者，对其手术前后食管液态测压和近期随访结果进行回顾性分析。结果：38例患者完成POEM和术后3 d 食管测压。术后3 d LESP 较术前显著降低（P ＜0．01），LES 松弛率与术前相比无明显差异。术前和术后3 d 食管体部均表现为蠕动性收缩消失，同步收缩比例增加。术后1个月随访，LESP 仍显著低于术前（P ＜0．05），37例患者吞咽困难明显好转，有效率为94．9％。结论：POEM治疗贲门失弛缓症近期内降低 LESP 和缓解临床症状效果明显，但对恢复食管蠕动功能作用有限。食管测压对贲门失弛缓症术后疗效评估有一定价值。
배경：분문실이완증적치료목적위강저하식관괄약기압력（LESP），감경경조，개선림상증상。경구내경하기절개술（POEM）근년래개시용우분문실이완증적치료。목적：통과분석수술전후식관동력적변화，평고 POEM치료분문실이완증적근기료효。방법：납입2011년12월～2012년10월재남경고루의원진단위분문실이완증병접수POEM치료적39례환자，대기수술전후식관액태측압화근기수방결과진행회고성분석。결과：38례환자완성POEM화술후3 d 식관측압。술후3 d LESP 교술전현저강저（P ＜0．01），LES 송이솔여술전상비무명현차이。술전화술후3 d 식관체부균표현위연동성수축소실，동보수축비례증가。술후1개월수방，LESP 잉현저저우술전（P ＜0．05），37례환자탄인곤난명현호전，유효솔위94．9％。결론：POEM치료분문실이완증근기내강저 LESP 화완해림상증상효과명현，단대회복식관연동공능작용유한。식관측압대분문실이완증술후료효평고유일정개치。
Background:The goals for treatment of achalasia are reducing lower esophageal sphincter pressure (LESP)and alleviating esophageal obstruction and its related symptoms.Peroral endoscopic myotomy (POEM)is a promising option for treating achalasia.Aims:To assess the short-term efficacy of POEM for treating achalasia by analyzing the dynamic changes in esophageal manometry.Methods:A retrospective study was conducted in 39 achalasia patients receiving POEM in Nanjing Drum Tower Hospital from Dec.2011 to Oct.2012.Data of water-perfusion esophageal manometry and one-month follow up were collected and analyzed.Results:Thirty-eight patients accomplished the POEM procedure and esophageal manometry three days after treatment.The post-POEM LESP was significantly reduced as compared with the pre-POEMones (P <0.01),while no significant difference was seen in LES relaxation rate before and after POEM.With regard to the motility of esophageal body,absence of peristalsis and increased synchronous contraction were observed both pre-and post-operatively.One month after POEM,LESP was still significantly lower than that before treatment (P <0.05).Thirty-seven patients had their dysphagia alleviated with an efficacy rate of 94.9%.Conclusions:POEM can reduce LESP and alleviate clinical symptoms of achalasia patients but has no effect on esophageal peristalsis during the short-term follow up.Esophageal manometry is useful for evaluating the short-term outcome postoperatively.