PDF(Pubmed)
Abstract：
There are various therapeutic options for achalasia. Nevertheless, peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy with fundoplication (LHM) are distinguished by their efficacy and low incidence of complications. Compare POEM and LHM regarding several outcomes in patients with achalasia. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An exhaustive literature search was performed using PubMed, Web of Science, and Cochrane Library databases. Studies comparing several outcomes between POEM and LHM in patients with achalasia were included. Data on clinical success, operative time, intraoperative complications, length of stay, reintervention rates, postoperative pain, overall complications, occurrence of GERD symptoms, use of proton bomb inhibitors and esophagitis were extracted. Quality assessment of the included studies was performed using the MINORS scale. We included 20 retrospective observational studies with a combined total of 5139 participants. The results demonstrated that there was no statistically significant difference in terms of intraoperative complications, postoperative complications, reintervention rate, occurrence of GERD symptoms, GERD HRQL, use of proton pump inhibitors, and esophagitis between POEM and LHM groups. Conversely, POEM was associated with higher clinical success and shorter operative time, length of stay, and postoperative pain. This meta-analysis concludes that both POEM and LHM, are effective and safe treatments for achalasia. However, POEM demonstrates better results regarding clinical success, operative time, length of stay, postoperative pain, and a tendency towards lower recurrence.
摘要：
贲门失弛缓症有多种治疗选择。然而，经口内镜肌切开术（POEM）和腹腔镜Heller肌切开术合并胃底折叠术（LHM）具有疗效和并发症发生率低的特点。比较POEM和LHM对贲门失弛缓症患者的几种结局。本系统评价是根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行的。使用PubMed进行了详尽的文献检索，WebofScience,和Cochrane图书馆数据库。包括比较POEM和LHM在贲门失弛缓症患者中的几种结果的研究。关于临床成功的数据，手术时间,术中并发症,逗留时间,再干预率，术后疼痛,整体并发症,出现GERD症状，使用质子弹抑制剂和食管炎进行提取。使用MINORS量表对纳入研究进行质量评估。我们纳入了20项回顾性观察研究，总共5139名参与者。结果表明，术中并发症没有统计学上的显着差异，术后并发症,再干预率，出现GERD症状，GERDHRQL,使用质子泵抑制剂，POEM组和LHM组之间的食管炎。相反，POEM与更高的临床成功率和更短的手术时间相关。逗留时间,和术后疼痛。这项荟萃分析得出的结论是，POEM和LHM，是贲门失弛缓症的有效和安全的治疗方法。然而,POEM在临床成功方面表现出更好的结果，手术时间,逗留时间,术后疼痛,和低复发率的趋势。
