经口内镜下肌切开术治疗贲门失弛缓症临床体会
|
摘要
目的:分析经口内镜下肌切开术(POEM)治疗贲门失弛缓(AC)的疗效和可行性。方法:回顾分析2015年8月—2018年8月收治的18例确诊为AC并行POEM治疗患者的临床资料,总结治疗效果及并发症等情况。结果:18例患者均顺利完成POEM术,1例发生肺部感染,1例发生纵隔气肿,经保守治疗后痊愈。结论:POEM作为一种新的内镜下微创手术,治疗AC近期疗效肯定,是治疗AC较为安全、有效的方法,可迅速缓解AC患者的吞咽困难症状。
Objective: To analyze the efficacy and feasibility of peroral endoscopic myotomy( POEM) for treatment of achalasia cardia( AC). Methods: The clinical data of 18 cases from August 2015 to August 2018 in hospital,who were diagnosed achalasia cardia and accepted POEM treatment,were reviewed. The curative effects and complications were analyzed. Results:All patients had completed POEM treatment,the lung infection occurred in 1 patients,mediastinal emphysema occurred in 1 patient. All complications were healed by conservative treatments. Conclusion: POEM is a promising new treatment for achalasia cardia resulting in short-time efficacy,which can relieve dysphagia,is a relatively safe and effective surgery,is worth to be popularized.
Objective: To analyze the efficacy and feasibility of peroral endoscopic myotomy( POEM) for treatment of achalasia cardia( AC). Methods: The clinical data of 18 cases from August 2015 to August 2018 in hospital,who were diagnosed achalasia cardia and accepted POEM treatment,were reviewed. The curative effects and complications were analyzed. Results:All patients had completed POEM treatment,the lung infection occurred in 1 patients,mediastinal emphysema occurred in 1 patient. All complications were healed by conservative treatments. Conclusion: POEM is a promising new treatment for achalasia cardia resulting in short-time efficacy,which can relieve dysphagia,is a relatively safe and effective surgery,is worth to be popularized.
引文
[1]GENNARO N,PORTALE G,GALLO C,et al.Esophageal achalasia in the Veneto region:epidemiology and treatment.Epidemiology and treatment of achalasia[J].J Gastrointest Surg,2011,15(3):423-428.
[2]BOECKXTAENS G E,ZANINOTTO G,RICHTER J E.Achalasia[J].Lancet,2014,383(9911):83-93.
[3]VAEZI M F,PANDOLFINO J E,VELA M F.ACG clinical guideline:diagnosis and management of achalasia[J].Am J Gastroenterol,2013,108(8):1238-1249.
[4]BECK W C,SHARP K W.Achalasia[J].Surg Clin North Am,2011,91(5):1031-1037.
[5]RICHTER J E.Esophageal motility disorder achalasia[J].Curr Opin Otolaryngol Head Neck Surg,2013,21(6):535-542.
[6]INOUE H,MONAMI H,KOBAYASHI Y,et al.Peroral endoscopic myotomy(POEM)for esophageal achalasia[J].Endoscopy,2010,42(4):265-271.
[7]BOECKXTAENS G E.The lower oesophageal sphincter[J].Neurogastroenterol Motil,2005,17(Suppl 1):13-21.
[8]CAMPOS G M,VITTINQHOFF E,RABL C,et al.Endoscopic and surgical treatments for achalasia:a systematic review and meta-analysis[J].Ann Surg,2009,249(1):45-57.
[9]BLATNIK J A,PONSKY J L.Advances in the treatment of achalasia[J].Curr Treat Options Gastroenterol,2014,12(1):49-58.
[10]WANG L,LI Y M,LI L.Meta-analysis of randomized and controlled treatment trials for achalasia[J].Dig Dis Sci,2009,54(11):2303-2311.
[11]ALLAIX M E,PATTI M G.Heller myotomy for achalasia.From the open to the laparoscopic approach[J].World J Surg,2015,39(7):1603-1607.
[12]周平红,蔡明琰,姚礼庆,等.经口内镜下环形肌切开术治疗42例贲门失弛缓症[J].中华胃肠外科杂志,2011,14(9):705-708.
[13]SHARATA A,KURIAN A A,DUNST C M,et al.Peroral endoscopic myotomy(POEM)is safe and effective in the setting of prior endoscopic intervention[J].JGastrointest Surg,2013,17(7):1199-1192.
[14]INOUE H,SATO H,IKEDA H,et al.Per-oral endoscopic myotomy:a series of 500 patients[J].J Am Coll Surg,2015,221(2):256-264.
[15]ELEFTHERIADIS N,INOUE H,IKEDA H,et al.Training in peroral endoscopic myotomy(POEM)for esophageal achalasia[J].Ther Clin Risk Manag,2012,8:329-342.
[16]令狐恩强,李惠凯.一种新的贲门失弛缓的内镜下分型[J].中华腔镜外科杂志(电子版),2011,4(5):334-336.
[2]BOECKXTAENS G E,ZANINOTTO G,RICHTER J E.Achalasia[J].Lancet,2014,383(9911):83-93.
[3]VAEZI M F,PANDOLFINO J E,VELA M F.ACG clinical guideline:diagnosis and management of achalasia[J].Am J Gastroenterol,2013,108(8):1238-1249.
[4]BECK W C,SHARP K W.Achalasia[J].Surg Clin North Am,2011,91(5):1031-1037.
[5]RICHTER J E.Esophageal motility disorder achalasia[J].Curr Opin Otolaryngol Head Neck Surg,2013,21(6):535-542.
[6]INOUE H,MONAMI H,KOBAYASHI Y,et al.Peroral endoscopic myotomy(POEM)for esophageal achalasia[J].Endoscopy,2010,42(4):265-271.
[7]BOECKXTAENS G E.The lower oesophageal sphincter[J].Neurogastroenterol Motil,2005,17(Suppl 1):13-21.
[8]CAMPOS G M,VITTINQHOFF E,RABL C,et al.Endoscopic and surgical treatments for achalasia:a systematic review and meta-analysis[J].Ann Surg,2009,249(1):45-57.
[9]BLATNIK J A,PONSKY J L.Advances in the treatment of achalasia[J].Curr Treat Options Gastroenterol,2014,12(1):49-58.
[10]WANG L,LI Y M,LI L.Meta-analysis of randomized and controlled treatment trials for achalasia[J].Dig Dis Sci,2009,54(11):2303-2311.
[11]ALLAIX M E,PATTI M G.Heller myotomy for achalasia.From the open to the laparoscopic approach[J].World J Surg,2015,39(7):1603-1607.
[12]周平红,蔡明琰,姚礼庆,等.经口内镜下环形肌切开术治疗42例贲门失弛缓症[J].中华胃肠外科杂志,2011,14(9):705-708.
[13]SHARATA A,KURIAN A A,DUNST C M,et al.Peroral endoscopic myotomy(POEM)is safe and effective in the setting of prior endoscopic intervention[J].JGastrointest Surg,2013,17(7):1199-1192.
[14]INOUE H,SATO H,IKEDA H,et al.Per-oral endoscopic myotomy:a series of 500 patients[J].J Am Coll Surg,2015,221(2):256-264.
[15]ELEFTHERIADIS N,INOUE H,IKEDA H,et al.Training in peroral endoscopic myotomy(POEM)for esophageal achalasia[J].Ther Clin Risk Manag,2012,8:329-342.
[16]令狐恩强,李惠凯.一种新的贲门失弛缓的内镜下分型[J].中华腔镜外科杂志(电子版),2011,4(5):334-336.