CAJ | 학술논문

背景：经口内镜下肌切开术（ POEM）是治疗贲门失弛缓症（ EA）的新技术，已有研究证实该法治疗EA可行、安全、有效，但关于术中全层肌切开与环肌切开疗效差异的报道尚少。目的：探讨POEM治疗EA的疗效和安全性。方法：2011年8月至2013年11月中南大学湘雅二医院收治EA患者216例，行POEM治疗，其中全层肌切开133例，环肌切开83例。术后对患者进行定期随访和复查，观察手术前后Eckardt评分和食管直径改变、术中、术后并发症发生情况和复发率，并比较全层肌切开与环肌切开疗效有无差异。结果：216例患者均成功实施POEM，操作时间平均为59.1 min，隧道长度平均为13.3 cm，肌切开长度平均为10.1 cm。术后患者症状均得到缓解，Eckardt评分较术前显著改善，术后6个月食管直径较术前显著缩小（53.7 mm对30.8 mm，P<0.001），并发症发生率为13.0%（28/216）。患者术后随访3~30个月（平均13.8个月），有效率为99.1%（214/216），随访期内无一例复发病例。全层肌切开与环肌切开相比，操作时间、有效率和并发症发生率差异均无统计学意义（ P>0.05）。结论：POEM可作为EA安全、有效的治疗手段；全层肌切开并不增加手术操作时间和手术相关并发症，但其远期疗效和并发症仍有待进一步随访评估。
배경：경구내경하기절개술（ POEM）시치료분문실이완증（ EA）적신기술，이유연구증실해법치료EA가행、안전、유효，단관우술중전층기절개여배기절개료효차이적보도상소。목적：탐토POEM치료EA적료효화안전성。방법：2011년8월지2013년11월중남대학상아이의원수치EA환자216례，행POEM치료，기중전층기절개133례，배기절개83례。술후대환자진행정기수방화복사，관찰수술전후Eckardt평분화식관직경개변、술중、술후병발증발생정황화복발솔，병비교전층기절개여배기절개료효유무차이。결과：216례환자균성공실시POEM，조작시간평균위59.1 min，수도장도평균위13.3 cm，기절개장도평균위10.1 cm。술후환자증상균득도완해，Eckardt평분교술전현저개선，술후6개월식관직경교술전현저축소（53.7 mm대30.8 mm，P<0.001），병발증발생솔위13.0%（28/216）。환자술후수방3~30개월（평균13.8개월），유효솔위99.1%（214/216），수방기내무일례복발병례。전층기절개여배기절개상비，조작시간、유효솔화병발증발생솔차이균무통계학의의（ P>0.05）。결론：POEM가작위EA안전、유효적치료수단；전층기절개병불증가수술조작시간화수술상관병발증，단기원기료효화병발증잉유대진일보수방평고。
Background:There have been several studies about peroral endoscopic myotomy( POEM)for treating esophageal achalasia( EA). Although the feasibility,safety and effectiveness of POEM have been demonstrated,comparative studies of full-thickness and circular muscle myotomy were rare. Aims:To evaluate the efficacy and safety of POEM for treating patients with EA. Methods:A total of 216 patients with EA admitted from Aug. 2011 to Nov. 2013 at the Second Xiangya Hospital of Central South University were treated with POEM,of whom 133 received full-thickness myotomy and 83 received circular muscle myotomy. Data about Eckardt ’s score, diameter of esophageal lumen, intra- and post-operative complications and recurrence before and/or during periodical follow-up were collected,and the efficacy of full-thickness and circular muscle myotomy was compared. Results:All the 216 patients successfully underwent POEM with an average operation time of 59. 1 minutes. Average length of tunnel and myotomy were 13. 3 cm and 10. 1 cm,respectively. Symptoms remitted in all of the 216 patients,Eckardt’s score decreased significantly,diameter of esophageal lumen was reduced(pre-treatment vs. 6 months after treatment,53. 7 mm vs. 30. 8 mm,P<0. 001),and complications occurred in 13. 0%(28/216)of the cases. Success treatment was achieved in 99. 1%(214/216)of the cases with a follow-up of 3-30 months( mean 13. 8 months),no recurrence was noted. The operation time,efficacy and complications were comparable between full-thickness and circular muscle myotomy(P>0. 05). Conclusions:POEM is an effective and safe method for treating EA. Full-thickness myotomy did not increase the operation time and procedure-related complications, however,its long-term efficacy and complications need to be further assessed.