目的:评估憩室经口内镜下肌切开术(D-POEM)治疗症状性食管憩室的中期和长期疗效。
方法:选取2016年5月1日至2020年4月1日在6个中心连续接受D-POEM的有症状食管憩室患者进行研究。通过改良的Eckardt评分评估的症状在D-POEM之前和之后的1、6、12、24和36个月进行登记。
结果:共34例Zenker憩室患者(ZD,n=12),食管中部憩室(MED,n=12),和上膈憩室(ED,包括n=10)。在平均39.15分钟内实现了完全的隔切开术,100%技术成功术中、术后无严重并发症发生。五名患者表现为皮下气肿,1例粘膜损伤。术前平均Eckardt评分为8.59,术后1个月平均为2.56,2.09在6个月时,2.21在12个月时,2.15在24个月时,术后36个月为2.21。术后1、6、12、24和36个月的临床总成功率为97.1%,97.1%,94.1%,91.2%,和88.2%,分别。中位随访时间为47.2个月,四名患者症状复发,临床总成功率为88.2%。疾病持续时间长,Eckardt的高分,通过多变量Cox分析确定贲门失弛缓症共存是症状性复发的危险因素。
结论:D-POEM是有症状的食管憩室患者的有效和持久的治疗方法。
To evaluate the medium- and long-term outcomes of diverticular peroral endoscopic myotomy (D-POEM) for symptomatic oesophageal diverticulum.
Consecutive patients with symptomatic oesophageal diverticulum who underwent D-POEM from 1st May 2016 to 1st April 2020 in 6 centres were extracted and researched. Symptoms assessed by the modified Eckardt score were registered pre- and post-D-POEM at 1, 6, 12, 24 and 36 months.
A total of 34 patients with Zenker\'s diverticulum (ZD, n = 12), mid-oesophageal diverticulum (MED, n = 12), and epiphrenic diverticulum (ED, n = 10) were included. Complete septotomy was achieved in a mean of 39.15 min, with 100% technical success. No severe intraoperative or postoperative complications were observed. Five patients exhibited subcutaneous emphysema, while 1 had mucosal injury. The mean Eckardt score was 8.59 preoperatively and 2.56 at 1 month, 2.09 at 6 months, 2.21 at 12 months, 2.15 at 24 months, and 2.21 at 36 months postoperatively. The total clinical success rates at 1, 6, 12, 24 and 36 months postoperatively were 97.1%, 97.1%, 94.1%, 91.2%, and 88.2%, respectively. With a median follow-up of 47.2 months, four patients suffered symptom relapse, with a total clinical success rate of 88.2%. A long disease duration, a high Eckardt score, and coexistence of achalasia were identified as risk factors for symptomatic recurrence by multivariable Cox analysis.
D-POEM is an effective and durable treatment for patients with symptomatic oesophageal diverticulum.