Peroral Endoscopic Myotomy for the Treatment of Achalasia: A Clinical Comparative Study of Endoscopic Full-Thickness and Circular Muscle Myotomy
Peroral Endoscopic Myotomy for the Treatment of Achalasia: A Clinical Comparative Study of Endoscopic Full-Thickness and Circular Muscle Myotomy
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DOI：
10.1016/j.jamcollsurg.2013.04.033
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发表时间：
2013-09-01
影响因子：
5.2
通讯作者：
Ren, Zhong
中科院分区：
文献类型：
--
作者：
Li, Quan-Lin;Chen, Wei-Feng;Ren, Zhong
背景技术背景：在贲门失弛缓症的经口内镜肌切开术（POEM）中，通常推荐保留纵向食管外肌层的环形肌切开术。但由于食管纵行肌纤维极细且脆弱，而肌切开术的完整性是传统手术肌切开术取得良好效果的基础，因此这种改良还需进一步讨论。在这里，我们回顾性分析了我们的前瞻性维护POEM数据库，比较内镜下全层和环形肌切开术的结果。研究设计：根据切开深度，103例全层肌切开术被分配到A组，而131例环形肌切开术被分配到组B。症状缓解，程序相关参数和不良事件，测压结果，反流并发症进行了比较groups.RESULTS：平均手术时间显着较短的A组相比，组B（p = 0.02）。全层肌切开术后任何手术相关不良事件均未增加（所有p < 0.05）。随访期间，治疗成功（Eckardt评分0.05）。总体临床反流并发症发生率也相似（21.2% vs 16.5%，p = 0.38）。结论：两种方法的短期症状缓解和测压结果相当。全层肌切开术显著缩短了手术时间，但未增加手术相关不良事件或临床反流并发症。((c)2013年美国外科医生学会）
BACKGROUND: A circular muscle myotomy preserving the longitudinal outer esophageal muscular layer is often recommended during peroral endoscopic myotomy (POEM) for achalasia. However, because the longitudinal muscle fibers of the esophagus are extremely thin and fragile, and completeness of myotomy is the basis for the excellent results of conventional surgical myotomy, this modification needs to be further debated. Here, we retrospectively analyzed our prospectively maintained POEM database to compare the outcomes of endoscopic full-thickness and circular muscle myotomy.STUDY DESIGN: According to the myotomy depth, 103 patients with full-thickness myotomy were assigned to group A, while 131 patients with circular muscle myotomy were assigned to group B. Symptom relief, procedure-related parameters and adverse events, manometry outcomes, and reflux complications were compared between groups.RESULTS: The mean operation times were significantly shorter in group A compared with group B (p = 0.02). There was no increase in any procedure-related adverse event after full-thickness myotomy (all p < 0.05). During follow-up, treatment success (Eckardt score 0.05). The overall clinical reflux complication rates were also similar (21.2% vs 16.5%, p = 0.38).CONCLUSIONS: Short-term symptom relief and manometry outcomes of each method were comparable. Full-thickness myotomy significantly reduced the procedure time but did not increase the procedure-related adverse events or clinical reflux complications. ((c) 2013 by the American College of Surgeons)