CAJ | 학술논문

目的探讨既往有内镜或外科Heller肌切开术治疗史的贲门失弛缓症(AC)患者行经口内镜下肌切开术(POEM)治疗的有效性和安全性.方法回顾性分析2011年10月至2014年4月间行POEM治疗的164例AC患者的临床资料,根据POEM术前是否进行过内镜或外科Heller肌切开术,分为复治组和初治组,比较围手术期资料及术前、术后患者Eckardt评分变化情况.结果复治组58例,初治组106例.2组患者的POEM成功率分别为94.8％ (55/58)和98.1％ (104/106),差异无统计学意义(P=0.09).所有患者中位随访时间17个月(6～30个月),术后症状明显改善,且术后1个月、12个月、24个月Eckardt评分(≤3分)较术前(4～11分)明显降低.随访期间复治组与初治组各有1例复发,症状缓解率98.7％ (157/159).复治组平均操作时间、住院天数及使用止血夹数量均多于初治组,分别是(70.8±20.7)min比(68.3 ±27.1)min、(7.7±1.9)d比(7.5±2.6)d、(13.0±5.7)个比(12.7±5.6)个,但2组比较差异均无统计学意义(P＞0.05).复治组和初治组并发症发生率分别是9.1％ (5/55)、8.7％ (9/104),差异也无统计学意义(P=0.93).结论既往有内镜或外科治疗史的AC患者,POEM治疗仍然安全有效.
목적 탐토기왕유내경혹외과Heller기절개술치료사적분문실이완증(AC)환자행경구내경하기절개술(POEM)치료적유효성화안전성.방법 회고성분석2011년10월지2014년4월간행POEM치료적164례AC환자적림상자료,근거POEM술전시부진행과내경혹외과Heller기절개술,분위복치조화초치조,비교위수술기자료급술전、술후환자Eckardt평분변화정황.결과 복치조58례,초치조106례.2조환자적POEM성공솔분별위94.8％ (55/58)화98.1％ (104/106),차이무통계학의의(P=0.09).소유환자중위수방시간17개월(6～30개월),술후증상명현개선,차술후1개월、12개월、24개월Eckardt평분(≤3분)교술전(4～11분)명현강저.수방기간복치조여초치조각유1례복발,증상완해솔98.7％ (157/159).복치조평균조작시간、주원천수급사용지혈협수량균다우초치조,분별시(70.8±20.7)min비(68.3 ±27.1)min、(7.7±1.9)d비(7.5±2.6)d、(13.0±5.7)개비(12.7±5.6)개,단2조비교차이균무통계학의의(P＞0.05).복치조화초치조병발증발생솔분별시9.1％ (5/55)、8.7％ (9/104),차이야무통계학의의(P=0.93).결론 기왕유내경혹외과치료사적AC환자,POEM치료잉연안전유효.
Objective To explore the clinical efficacy and safety of peroral endoscopic myotomy (POEM) for achalasia(AC) with or without prior endoscopic or surgical procedures.Methods The clinical data of 164 patients with severe achalasia who were admitted to our hospital from October 2011 to April 2014 were retrospectively analyzed.They were assigned to the retreatment group and the initial treatment group.The perioperative clinical data and Eckwardt scores before and after the operation were compared.Results A total of 164 patients were enrolled, 58 of whom already received prior endoscopic or surgical procedures for therapy were in the retreatment group, and the other 106 patients of whom hadn't any treatment for achalasia were in the initial treatment group.The success rates of POEM in two groups were 94.8％ (55/58) and 98.1％ (104/106) , with no significant difference (P ＞ 0.05).Median follow-up time was 17 months (ranging 6-30) , and the symptoms of patients relieved after treatment.The Eckardt scores at 1,12 and 24 months after the operation were ≤ 3, which were lower than that before operation (4-11).During follow-up time, one recurrence happened in each group, and symptom relief rate was 98.7％ (157/159).The operation time , hospital stay and number of Hemostatic clips in the retreatment group was more than that of initial group , (70.8 ±20.7)min VS(68.3 ±27.1) min,(7.7 ± 1.9)day VS (7.5 ±2.6)day, (13.0 ±5.7) piece VS (12.7 ± 5.6) piece, respectively, with no significant difference (P ＞ 0.05).The incidence of complications of the retreatment group and initial group were 9.1％ (5/55) and 8.7％ (9/104), with no significant difference (P =0.93).Conclusion POEM is an effective and safe method for the AC who have previous endoscopic or surgical treatment.