背景:虽然肌切开术在经口内镜肌切开术(POEM)手术中至关重要,其最佳长度仍然存在争议。在这里,我们提出了一种改良的POEM,具有新的定制肌切开术长度的方法,旨在评估安全性,功效,以及与标准POEM相比,该改良POEM在I型或II型贲门失弛缓症的临床结果。
方法:回顾性分析2018年1月至2022年12月在吉林大学第一医院接受POEM治疗的75例I型或II型门失弛缓症患者。根据肌切开术,这些患者被分为按需逆行肌切开术(RDM,n=34),通过确定食管下括约肌(LES)扩张的程度,从胃侧和长度开始切开术,和标准肌切开术(SM,n=41)组。基线数据,肌切开术长度,操作时间,临床成功率,不良事件发生率,并对与反流相关的不良事件进行比较分析。
结果:RDM组的中位肌切开术长度明显短于SM组(6vs.8厘米,分别为;p<0.001)。此外,RDM组的中位肌切开术时间明显短于SM组(10vs.16分钟,分别为;p<0.001)。所有患者均成功实施POEM。在2年的随访中,在RDM和SM组中观察到较高的临床成功率(92.0%vs.93.3%,分别为;p=1.000)。两组的术中不良事件和术后反流相关不良事件发生率较低,具有可比性。
结论:RDMPOEM是I型或II型贲门失弛缓症患者安全有效的治疗方法。此外,与标准POEM技术相比,它的肌切开术长度和手术时间更短。
BACKGROUND: Although myotomy is crucial in peroral endoscopic myotomy (POEM) surgeries, its optimum length remains controversial. Herein, we propose a modified POEM with new method of tailoring myotomy length aim to evaluate the safety, efficacy, and clinical outcomes of this modified POEM compared with standard POEM in type I or II
achalasia.
METHODS: Seventy-five patients with type I or II
achalasia who underwent POEM at the First Hospital of Jilin University between January 2018 and December 2022 were retrospectively analyzed. According to the myotomy approach, these patients were divided into the retrograde on-demand myotomy (RDM, n = 34), with myotomy beginning on gastric side and length tailored by determining the degree of lower esophageal sphincter (LES) distention, and standard myotomy (SM, n = 41) groups. The baseline data, myotomy length, operation time, clinical success rate, adverse event rate, and reflux-related adverse events were compared and analyzed.
RESULTS: The median myotomy length in the RDM group was significantly shorter than that in the SM group (6 vs. 8 cm, respectively; p < 0.001). Moreover, the median myotomy time in the RDM group was significantly shorter than that in the SM group (10 vs. 16 min, respectively; p < 0.001). POEM was successfully performed in all the patients. At the 2-year follow-up, high clinical success rates were observed in both the RDM and SM groups (92.0% vs. 93.3%, respectively; p = 1.000). The incidence of intraoperative adverse events and postoperative reflux-related adverse events was low and comparable in both groups.
CONCLUSIONS: RDM POEM is a safe and effective method for patients with type I or II
achalasia. Furthermore, it has a shorter myotomy length and operation time than standard POEM technique.