CAJ | 학술논문

目的探讨经口内镜下肌切开术(POEM)治疗贲门失弛缓症的疗效及安全性.方法对40例贲门失弛缓症患者进行POEM治疗,手术前后评估症状及食管造影、食管测压、胃镜等检查,于术后第6天、1个月、3个月、6个月评估疗效,并观察手术并发症.结果 40例贲门失弛缓症患者均顺利完成POEM,手术时间(57.2±18.4)min,术中有2例出现纵隔和皮下气肿.术后缓解率100％(Eckardt评分≤3分),平均随访13.3个月,复发2例,半年缓解率90％.食管测压术前食管下括约肌平均静息压30.6 mmHg(1 mmHg =0.133 kPa),术后15.8 mmHg(P=0.001);术前平均综合松弛压28.1 mmHg,术后12.2 mmHg(P=0.000);平均食管最宽径术前4.2 cm,术后3.1 cm(P＜0.001).结论 POEM治疗贲门失弛缓症安全、有效,短期疗效肯定,并发症少,长期疗效及远期并发症有待随访研究.
목적 탐토경구내경하기절개술(POEM)치료분문실이완증적료효급안전성.방법 대40례분문실이완증환자진행POEM치료,수술전후평고증상급식관조영、식관측압、위경등검사,우술후제6천、1개월、3개월、6개월평고료효,병관찰수술병발증.결과 40례분문실이완증환자균순리완성POEM,수술시간(57.2±18.4)min,술중유2례출현종격화피하기종.술후완해솔100％(Eckardt평분≤3분),평균수방13.3개월,복발2례,반년완해솔90％.식관측압술전식관하괄약기평균정식압30.6 mmHg(1 mmHg =0.133 kPa),술후15.8 mmHg(P=0.001);술전평균종합송이압28.1 mmHg,술후12.2 mmHg(P=0.000);평균식관최관경술전4.2 cm,술후3.1 cm(P＜0.001).결론 POEM치료분문실이완증안전、유효,단기료효긍정,병발증소,장기료효급원기병발증유대수방연구.
Objective To evaluate the efficacy and safety of peroral endoscopic myotomy (POEM) for achalasia.Methods A total of 40 achalasia patients who underwent POEM at our hospital were enrolled.The outcomes of Eckardt score,Barium contrast imaging,esophageal manometry as well as esophagogastroscopy were assessed before and at 6th day,1 month,3 months and 6 months after POEM respectively.Results All 40 patients successfully underwent POEM,with the mean operation time 57.2 ± 18.4 minutes.lntraoperative mediastinal and subcutaneous emphysema occurred on two patients.All patients had significant symptom relief after POEM (Eckardt score ≤ 3).The patients had a mean follow-up of 13.3 months.Two patients had symptom relapse,and treatment success rate (Eckardt score ≤3) was 90％ in 6-month follow up.According to high-resolution manometry (HRM),the resting lower esophageal sphincter (LES) pressures were 30.6 and 15.8 mmHg (P =0.001),and intergrated relaxation pressure(IRPs) were 28.1 and 12.2 mmHg (P =0.000) before and after POEM,respectively.The diameter of the esophageal lumen was 4.2 cm and 3.1 cm before and after POEM (P＜0.001).Conclusion POEM is safe and effective in a short term with less complications.Further follow-up studies are needed to evaluate long-term outcomes.