腹腔镜Heller手术与经口内镜下肌切开术治疗贲门失弛缓症的临床效果比较

蒋彬; 张灵敏; 孙天宇; 谭群友; 王如文

doi:10.16016/j.1000-5404.201907234

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腹腔镜Heller手术与经口内镜下肌切开术治疗贲门失弛缓症的临床效果比较

临床医学 | 更新时间：2026-01-09

- 腹腔镜Heller手术与经口内镜下肌切开术治疗贲门失弛缓症的临床效果比较
- Laparoscopic Heller myotomy versus peroral endoscopic myotomy for achalasia: safety, efficacy and complications
- 第三军医大学学报 2019年41卷第22期页码：2199-2204
- 作者机构：
  
  400042 重庆，陆军军医大学(第三军医大学)大坪医院全军胸外科研究所
- 作者简介：
  
  [王如文，E-mail:Wangrw53@126.com WANG Ruwen, E-mail:Wangrw53@126.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201907234
  中图分类号： R181.31;R573.7;R656.61
- 收稿：2019-07-25，
  
  修回：2019-09-27，
  
  纸质出版：2019-11-30
- 稿件说明：
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蒋彬, 张灵敏, 孙天宇, 等. 腹腔镜Heller手术与经口内镜下肌切开术治疗贲门失弛缓症的临床效果比较[J]. 第三军医大学学报, 2019,41(22):2199-2204.

Bin JIANG, Lingmin ZHANG, Tianyu SUN, et al. Laparoscopic Heller myotomy versus peroral endoscopic myotomy for achalasia: safety, efficacy and complications[J]. Journal of Third Military Medical University, 2019, 41(22): 2199-2204.
蒋彬, 张灵敏, 孙天宇, 等. 腹腔镜Heller手术与经口内镜下肌切开术治疗贲门失弛缓症的临床效果比较[J]. 第三军医大学学报, 2019,41(22):2199-2204. DOI： 10.16016/j.1000-5404.201907234.

Bin JIANG, Lingmin ZHANG, Tianyu SUN, et al. Laparoscopic Heller myotomy versus peroral endoscopic myotomy for achalasia: safety, efficacy and complications[J]. Journal of Third Military Medical University, 2019, 41(22): 2199-2204. DOI： 10.16016/j.1000-5404.201907234.

摘要

目的

比较腹腔镜Heller手术(laparoscopic heller myotomy，LHM)和经口内镜下肌切开术(peroral endoscopic myotomy，POEM)治疗贲门失弛缓症的临床疗效，探讨POEM术后胃食管反流并发症的治疗策略。

方法

采用回顾性队列研究的方法，收集2012年10月至2017年4月我院收治的61例贲门失弛缓症患者的临床资料，其中30例行腹腔镜Heller手术加部分胃底折叠术(Dor)为腹腔镜组(LHM组)；31例行经口内镜下肌切开术为内镜组(POEM组)，随访至2019年4月，比较两组患者的基本资料、手术情况、临床疗效以及胃食管反流并发症(包括胃食管反流症状、病理性酸反流、食管炎)的情况。

结果

患者均顺利完成手术，无围术期死亡。LHM组和POEM组患者在手术时间、术中出血量、围术期并发症、平均住院日、住院费用等方面差异无统计学意义。LHM组和POEM组的治疗有效率分别为86.7%(26/30)和90.3%(28/31)，差异无统计学意义。两组患者术后Ecardt评分、下段食管静息压较术前均明显下降(

0.001)，但两组之间比较，差异无统计学意义；POEM组术后胃食管反流症状(3/27

11/20

=0.018)、病理性酸反流(4/26

12/18

=0.024)、食管炎(2/28

9/22

=0.023)发生率显著高于LHM组。临床相关胃食管反流发生率在POEM组更高(1/29

7/24

=0.026)。

结论

LHM与POEM治疗贲门失弛缓症的安全性及中远期疗效相近，但是POEM手术缺乏抗反流措施，可导致胃食管反流发生率升高，术后应密切随访并积极干预。

Abstract

Objective

To compare the clinical efficacy of laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM) for treatment of achalasia

and investigate the strategy for management of gastroesophageal reflux disease (GERD) after POEM.

Methods

This retrospective cohort study was conducted among 61 patients undergoing minimally invasive surgery for achalasia in our hospital between October

2012 and April

2017. Of the 61 patients

30 underwent LHM with Dor fundoplication (LHM group) and 31 underwent POEM. All patients were followed up to April

2019. The general and perioperative data

clinical efficacy

and incidence of GERD complications (including GERD symptoms

pathological acid reflux and esophagitis) were compared between the 2 groups.

Results

The operations were completed smoothly in all the patients without perioperative death. There were no significant differences between LHM and POEM groups in the operation time

intraoperative blood loss

perioperative complications

mean hospital stay or hospital costs. The 2 operations produced similar therapeutic effective rate [86.7% (26/30)

90.3%(28/31)

0.05

]

and the Ecardt score and the lower esophageal sphincter pressure were decreased significantly in both groups after the operation (

0.001)

but there were no difference between the 2 operations. Compared with LHM

POEM was associated with significantly higher incidences of GERD symptoms (3/27

11/20

=0.018)

pathological acid reflux (4/26

12/18

=0.024)

and esophagitis (2/28

9/22

=0.023); the incidence of clinically relevant GERD was much higher in POEM group than in LHM group (1/29

7/24

=0.026).

Conclusion

LHM and POEM have similar safety and mid- and long-term efficacies for treatment of achalasia

but the absence of an antireflux wrap in POEM surgery leads to an increased risk of GERD. Patients planning to undergo POEM surgery should be closely followed after the surgery and given timely implementation of active interventions.

关键词

Keywords

references

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