摘要目的 探讨经食管后壁内镜肌切开术(POEM)治疗贲门失弛缓症的有效性及安全性.方法 选择诊断明确的贲门失弛缓症患者,经食管后壁行POEM,观察手术前后患者的吞咽困难的积分、食管下括约肌静息压变化、手术并发症等.结果 28例贲门失弛缓症患者入选研究,其中26例患者顺利施行经食管后壁的POEM,平均手术时间68.8 min,无一例患者发生严重危及生命的手术并发症.26例患者术后食管下括约肌静息压力较术前平均降低16.37 mm Hg(1 mmHg =0.133 kPa),术后1个月Eckardt评分均分较术前降低6.69分,仅1例患者仍有吞咽困难,Eckardt评分为4分,总有效率96.1％ (25/26).1例患者术后出现反流症状.2例患者因贲门部严重疤痕形成而未能完成POEM手术.结论 经食管后壁POEM能即时有效地改善贲门失弛缓症患者吞咽困难的临床症状,有效降低食管下括约肌静息压力,短期疗效满意,其并发症尤其是气胸发生率较低,安全性较高.

abstractsObjective To explore the clinical efficacy and safety of peroral endoscopic myotomy (POEM) via posterior wall of esophagus for cardia achalasia (AC).Methods The patients who were diagnosed with AC by esophageal barium meal and pull-through esophageal manometry were enrolled in this study.Pre-and postoperative dysphagia score and lower esophageal sphincter relaxation pressure (LESRP) were employed to evaluate short-term efficacy of POEM for achalasia.Operation related complications were observed to assess safety of POEM via posterior wall.Results A total of 28 patients were enrolled,of whom,26 were treated successfully by POEM via posterior wall of esophagus,with a mean operation time of 68.8 min.The procedure was discontinued in other two patients due to severe submucosal scar at cardia.No fatal intra-or postoperative complications occurred during POEM.The mean LESRP decreased by 16.37 mm Hg after POEM.One month after POEM,the mean Eckardt dysphagia symptom score was reduced by 6.69,with a total efficiency rate of 96.1％ (25/26).Reflux symptoms developed in 1 patient after POEM.Conclusion POEM via posterior esophageal wall could efficiently improve the clinical symptoms of dysphagia and decrease LESRP in achalasia patients,which is also safe with lower rate of postoperative complication.