经口内镜下肌切开术治疗贲门失弛缓症

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1、经口内镜下肌切开术治疗贲门失弛缓症：45例报告发布日期：2011-6-2213:09:42作者:周平红姚礼庆蔡明琰钟芸诗任重徐美东陈巍峰秦新裕【摘要】目的探i、J•经口闪镜下肌切开术(POEM)治疗贲门失弛缓症(AC)的疗效和可行性。方法回顾性研究2010年8W至2011年4月确诊为AC井接受POEM治疗的45例患者的临床资料。POEM的主要步骤乜括：食管黏膜层切开；分离黏膜下层，建立黏膜下“隧道”；胃镜直视F切开环形肌；金属火关闭黏膜层切U。结果所有45例患者均成功接受POEM术，平均年龄43.9岁(10-

2、70)，平均病程8.7y(3m-50y)，平均平术时间68.5min(23-180)，黏膜下隧道平均氏度10.5cm(8-15)，环形肌切开平均长度9.5cm(7-13),无1例岀现勾POEM相关的严重并发症。术后随访，44例吞咽W难明砧将到解除；丨例术后15d出现进食W难及呕吐，胃镜检查发现黏膜K窦道形成，行内镜下窦道切开。平均随访时间2.5m(1-6)。结论作为一种新的微创治疗方法，POEM治疗AC短期疗效肯定，可以迅速解除AC患者吞咽W难，似其长期疗效及远期并发症仍有待随访和观察。【关键词】贲门失弛缓症

3、内镜肌切开术Peroralendoscopicmyotomy(POEM)foresophagealachalasia:34casesreportZHOUPinghong,YAOLiqing,CAIMingyan，ZHONGYunshi,RenZhong，XUMeidong，CHENWcifcng,QINXinyu.EndoscopyCenter，ZhongshanHospital，FudanUniversity,Sahnghai200032,ChinaCorrespondingauthor:YAOLiqing

4、,Email:zhou1968@yahoo.cn[Abstract]ObjectiveToevaluatetheefficacyandthefesibilityofperoralendoscopicmyotomy(POEM)foresophagealachalasia(AC).PatientsandmethodsTheclinicaldataof34patientsdiagnosedasACandreceivedPOEMwerereviewedretrospectivelyinourcenterduringA

5、ugust2010andApril2011.ThekeyproceduresofPOEMwereasfollowing,1)esophagealmucosalincision，2)submucosal“tunnelling”byendoscopicsubmucosaldissection(ESD)technique,3)endoscopicmyotomyofthecircularmuscle，4)closureofmucosalentrybyhemostaticclips.ResultsAll45patien

6、tsreceivedPOEMsuccessfully.Theaverageagewas43.9years(range10-70).Theaveragedurationofsymptomswere8.7years(range3m-50y).Themeanoperationtimewas68.5min(range23-180)withameansubmucosaltunnellinglengthof10.5cm(range8-15).Theaveragelengthofendoscopicmyotomyofinn

7、ercircularmusclewas9.5cm(range7-13).NoseriouscomplicatiosrelatedtoPOEMwereencountered.Dysphagiasymptomwasrelievedsignificantlyduringthefollow-upperiodin44patients;onepatientre-occurreddysphagiaandvomiting15daysaftertheoperation，endoscopicobservationrevealin

8、gasubmucosalfistulawhichwasmanagedbyendoscopicincision.Themeanfollow-upperiodwas2.5m(range1-6).ConclusionAsanewminimallyinvasivetherapyforAC，POEMseemstobeveryeffectivetorelievepatient’sdysphagiasymptom