经口内镜下肌切开术治疗不同食管形态贲门失弛缓症的临床疗效分析
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董向前,男,博士,副教授。 中华医学会消化内 镜分会消化道早癌协作组青年委员,中华医学会消化病学分会内镜 协作组委员,中华医学会消化病学分会营养支持与治疗协作组委 员,中国人体健康科技促进会肠息肉防治专委会委员,云南省医学 会消化病学分会青委会副主任委员,云南省医学会消化内镜分会委 员、早癌诊治学组组长,云南省医院协会消化内科专委会副主任委 员,国家卫健委疾病控制局癌症早诊早治项目(农村)专委会-中国 消化道早癌内镜专业导师。 主要研究方向:消化内镜微创诊疗,炎 症性肠病基础及临床研究。

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国家自然科学基金资助项目(编号:82160113);云南省“兴滇英才支持计划”名医专项(编号:RLMY20220007)


Analysis of the clinical efficacy of peroral endoscopicmyotomy in the treatment of achalasia with different esophageal morphologies
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    摘要:

    目的 探讨不同食管形态的贲门失弛缓症(achalasia,AC)患者行经口内镜下肌切开术(peroral endoscopic myotomy,POEM)的安全性和有效性。 方法 采用前瞻性研究的方法选取 2022 年 11 月至 2024 年 12 月我院消化内科诊断为 AC 并行 POEM 治疗的患者,根据日本食管学会出版的食管 AC 描述规则对食管的形态进行分类,其中直型食管组(St 组)27 例 (食管下长轴夹角相交呈≥135°),乙状结肠型食管组[Sg 组(包含 aSg)]13 例(食管下长轴夹角相交呈<135°),对比两组术 前、术中各类参数,并分析两组行 POEM 后的治疗结局。 结果 Sg 组症状持续时间、食管钡剂造影结果中的食管扩张直径、既 往接受过治疗的患者人数均大于 St 组(P<0. 05),两组 Eckardt 评分、性别、年龄、身体质量指数(body mass index,BMI)、发病年 龄、高分辨率食管测压(high-resolution manometry,HRM)资料、食管钡剂造影结果中的食管下端狭窄直径比较,差异无统计学 意义(P>0. 05);两组手术时间、手术出血量及术后相关不良事件发生比较,差异无统计学意义( P>0. 05);两组术后 Eckard 评 分均≤3 分,且 40 例患者术前 Eckard 评分与术后 3 月及 6 月 Eckard 评分比较,差异均有统计学意义( P<0. 001),两组术前与 术后 Eckard 评分差值、术后 Eckard 评分、术后胃食管反流病(gastroesophageal reflux disease,GERD)发病人数、术后住院天数差 异均无统计学意义(P>0. 05)。 结论 Sg 型与 St 型 AC 对比,其症状持续时间明显较长,并且既往接受过内镜下或外科手术 治疗的比例也越高,但临床症状可能并未随着疾病的进展而更为严重。 POEM 对 St 型及 Sg 型不同食管形态的 AC 患者均是 可行、有效并且安全的

    Abstract:

    Objective To investigate the safety and effectiveness of peroral endoscopic myotomy (POEM) in the treatment ofachalasia (AC) patients with variant esophageal morphologies. Methods A prospective study was conducted. From November 2022 toDecember 2024, patients diagnosed as AC and treated with POEM at the department of gastroenterology in our hospital were selected.Based on the Japanese Esophageal Society’s classification criteria, the patients were divided into a straight-type esophagus group (Stgroup, n=27) and a sigmoid-type esophagus group (Sg group, n= 13). The St group had lower esophageal long-axis angle≥135°.The Sg group including aSg had lower esophageal long-axis angle <135°. Preoperative, intraoperative parameters, and postoperativeoutcomes were compared between the two groups. Results Symptom duration, esophageal dilation diameter on barium esophagography,and proportion of patients with prior treatments in the Sg group were longer or larger or higher than those in the St group (P<0. 05).There were no significant differences in Eckardt scores, gender, age, body mass index (BMI), age of onset, data of high-resolutionmanometry (HRM) and diameter of lower esophageal stenosis on barium esophagography between the two groups (P>0. 05). Therewere no significant differences in operative time, intraoperative bleeding, and postoperative adverse events between the two groups (P>0. 05). Postoperative Eckardt scores of both groups were≤3. However, there was significant difference when the Eckard scores of the40 patients before surgery were compared with those after 3 months and 6 months of surgery (P<0. 001). There were no significantdifferences in pre-to-postoperative Eckardt score changes, incidence of postoperative gastroesophageal reflux disease (GERD) and postoperative hospital stay (P>0. 05). Conclusions Sg-type AC patients have longer symptom duration and higher rates of prior interventions compared to St-type patients. However, disease progression is not correlated with symptom severity. POEM is a feasible, effective, and safe treatment for AC patients with both St-type and Sg-type esophageal morphologies.

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杨淳喻,马岚青,张 磊,杨刚,吴玉萍,邓任迪,董向前.经口内镜下肌切开术治疗不同食管形态贲门失弛缓症的临床疗效分析[J].实用医院临床杂志,2025,22(5):33-38

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  • 收稿日期:2025-07-01
  • 最后修改日期:2025-07-23
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  • 在线发布日期: 2025-09-29
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