CAJ | 학술논문

目的比较横开口法与纵开口法经口内镜下肌切开术（POEM）治疗贲门失弛缓症（AC）病人的手术效率和安全性。方法分析2010年12月~2012年09月间在我院行POEM术的53例AC患者的临床资料，包括患者一般情况，手术相关时间、并发症发生情况等资料。结果53例患者均顺利完成POEM，其中横开口法组41例，纵开口法12例，平均随访5月（3~24月），症状缓解率96.2%（51/53）。术后Eckardt评分较术前明显改善（7.5 vs 0.6，P<0.05）。横开口组手术用时65.0±18.0 min，略快于纵开口组74.1±18.2 min，但在隧道建立和环形肌切开过程中，明显快于纵开口法组36.3±9.0 min vs 45.4±10.5 min；10.2±4.6 min vs 15.5±5.5 min P<0.05）。同时，横开口组在皮下积气等气体相关并发症发生率低于纵开口法组（9.8%(4/41) vs 41.7%(5/12) P<0.05）。横开口组中另有4例术中发生黏膜穿孔（4/41，9.8%）。4例内镜下有反流性食管炎表现（4/537.5%），LA-A、LA-B级各2例，其中1例无明显症状。两组均无均无胸腔积液，出血，纵膈炎及消化道瘘等并发症的发生。结论横开口法POEM不仅有效显著缓解患者症状，且更能缩短手术时间，降低皮下气肿、气胸等气体相关并发症的发生率。
목적비교횡개구법여종개구법경구내경하기절개술（POEM）치료분문실이완증（AC）병인적수술효솔화안전성。방법분석2010년12월~2012년09월간재아원행POEM술적53례AC환자적림상자료，포괄환자일반정황，수술상관시간、병발증발생정황등자료。결과53례환자균순리완성POEM，기중횡개구법조41례，종개구법12례，평균수방5월（3~24월），증상완해솔96.2%（51/53）。술후Eckardt평분교술전명현개선（7.5 vs 0.6，P<0.05）。횡개구조수술용시65.0±18.0 min，략쾌우종개구조74.1±18.2 min，단재수도건립화배형기절개과정중，명현쾌우종개구법조36.3±9.0 min vs 45.4±10.5 min；10.2±4.6 min vs 15.5±5.5 min P<0.05）。동시，횡개구조재피하적기등기체상관병발증발생솔저우종개구법조（9.8%(4/41) vs 41.7%(5/12) P<0.05）。횡개구조중령유4례술중발생점막천공（4/41，9.8%）。4례내경하유반류성식관염표현（4/537.5%），LA-A、LA-B급각2례，기중1례무명현증상。량조균무균무흉강적액，출혈，종격염급소화도루등병발증적발생。결론횡개구법POEM불부유효현저완해환자증상，차경능축단수술시간，강저피하기종、기흉등기체상관병발증적발생솔。
Objective To compare the safety and efficiency of transverse-incision peroral endoscopic myotomy (POEM) with longitudinal-incision POEM. Methods POEM, with a transverse or longitudinal entry incision, was performed in 53 consecutive patients with confirmed achalasia (AC) between December 2010 and September 2012. Data of those patients was collected including the time spent for different procedures and complications. Results All the 53 patients underwent POEM successfully, among whom 41 patients had a transverse entry incision and 12 had a longitudinal incision. Treatment success (Eckardt score≤3) with a follow-up for 3-24 months (median 5 month) was achieved in 96.2% of the cases (mean score pre-treatment vs. post-treatment: 7.5 vs 0.6, P<0.001). The whole operation time of transverse-incision group was slightly shorter than that of longitudinal-incision group (65.0±18.0 min vs 74.1±18.2 min, P=0.142), but it took much less time in tunnel built-up and muscle dissection in the transverse-incision group (36.3±9.0 min vs 45.4±10.5 min;10.2±4.6 min vs 15.5±5.5 min, P<0.05). In addition, patients in transverse incision group were much less likely to develop pneumatosis-related complications [9.8% (4/41) vs 41.7% (5/12), P<0.05). No serious complications occurred in these two groups such as pleural effusion, mediastinitis or digestive tract fistula. Conclusions POEM with a transverse entry incision can significantly decrease the operation time and reduce the incidence of pneumatosis-related complications while obviously relieving the symptoms.