背景:本研究的目的是比较肌切开术深度的影响(选择性内层肌切开术(SIM)与全层肌切开术(FTM))对POEM治疗贲门失弛缓症患者的预后。
方法:这是一个回顾性研究,观察,2018年10月至2022年9月在两个三级中心进行。患者分为两组:SIM和FTM。主要终点是6个月时的临床疗效,而次要终点是术后标准(如疼痛,住院时间,并发症)和胃食管反流病(GERD)(6个月时的食管炎,胃灼热,和pH测定)。
结果:158例患者纳入研究(FTM组33例,SIM组125例)。两组6个月和12个月的成功率相似,SIM组为84%和70%,FTM组为90%和80%,分别(p=0.57和p=0.74)。然而,与SIM组相比,FTM组消耗了更多的阿片类镇痛药(41%vs21%,p<0.01)。FTM组的住院时间长于SIM组(2.17±2.62vs2.94±2.33,p<0.001)。6个月时食管炎的发生率相当(SIM组为16%,FTM组为12%,p=0.73)。SIM组和FTM组在6个月或12个月时的胃灼热没有显着差异(18.5%vs3.8%,p=0.07和27%vs12.5%,p分别=0.35)。
结论:FTM和SIM在临床疗效和GERD发生方面无显著差异。然而,全层肌切开术与更多的术后疼痛和更长的住院时间相关.因此,选择性内部肌切开术应优于全层肌切开术。
BACKGROUND: The aim of this study was to compare the impact of the depth of myotomy (selective inner layer myotomy (SIM) vs. full-thickness myotomy (FTM)) on the outcome of patients treated with POEM for achalasia.
METHODS: This was a retrospective, observational, conducted in two tertiary centers between October 2018 and September 2022. Patients were divided into two groups: SIM and FTM. The primary endpoint was clinical efficacy at 6 months, while secondary endpoints were postoperative criteria (such as pain, length of hospital stay, complications) and occurrence of gastroesophageal reflux disease (GERD) (esophagitis at 6 months, heartburn, and pH-metry).
RESULTS: 158 patients were included in the study (33 in the FTM group and 125 in the SIM group). The success rates at 6 and 12 months were similar in both groups, with 84 % and 70 % in the SIM group versus 90 % and 80 % in the FTM group, respectively (p = 0.57 and p = 0.74). However, more opioid analgesics were consumed in the FTM group compared to the SIM group (41% vs 21 %, p < 0.01). The length of hospitalization was longer in the FTM group than in the SIM group (2.17 ± 2.62 vs 2.94 ± 2.33, p < 0.001). The rate of esophagitis at 6 months was comparable (16 % in the SIM group vs 12 % in the FTM group, p = 0.73). There was no significant difference in terms of heartburn at 6 or 12 months between the SIM and FTM groups (18.5% vs 3.8 %, p = 0.07 and 27% vs 12.5 %, p = 0.35, respectively).
CONCLUSIONS: There was no significant difference in terms of clinical efficacy and GERD occurrence between FTM and SIM. However, full-thickness myotomy was associated with more postoperative pain and a longer length of hospital stay. Therefore, selective internal myotomy should be preferred over full-thickness myotomy.