摘要目的 探讨经口内镜下肌切开术(POEM)与球囊扩张术(PD)治疗贲门失弛缓症(AC)的优缺点.方法 2011年1月至2014年9月,确诊为AC并在第三军医大学西南医院行内镜治疗者,根据患者的食管情况以及患者本人或其家属的治疗愿望选择治疗方式,选择POEM治疗者纳入POEM组(n=56),选择PD治疗者纳入PD组(n=30),对比2组术后临床症状缓解情况、术后食管最大直径变化、并发症发生情况、住院时间及费用.结果 2组基线资料,包括患者性别构成、年龄、BMI、食管最大直径、Eckardt评分及病程方面,差异均无统计学意义(P>0.05).术后1、6、12个月时的Eckardt评分,2组均较术前有明显降低(P<0.05).术后1个月时,2组间Eckardt评分比较差异无统计学意义(P>0.05);术后6个月时,2组间Eckardt评分未见统计学差异(P=0.056),治疗有效率POEM组高于PD组[93%(52/56)比80%(24/30),χ2=0.115,P=0.076],但POEM组食管最大直径明显小于PD组[(25.39± 7.12)mm比(32.12± 9.99)mm,t=3.612,P=0.001];至术后12个月时, POEM组Eckardt评分明显低于PD组[(0.44±0.85)分比(1.26±1.74)分,t=2.940,P=0.004],治疗有效率明显高于PD组[93%(52/56)比80%(24/30),χ2=0.115,P=0.076].POEM组气体并发症发生率为32%(18/56),PD组无一例发生,2组间差异有统计学意义(χ2=12.195,P=0.000).POEM组平均住院时间(12.33±4.13)d,PD组为(6.50±2.28)d,差异有统计学意义(W=616,P=0.000).住院费POEM组为(8013.283± 4322.695)元,PD 组为(1571.018± 1590.193)元,差异有统计学意义(W=505,P=0.000).结论 POEM与PD治疗AC短期均有效.POEM短期疗效更好,疗效持续时间更长;而PD适应证范围更广,操作更为简单,并发症少,住院时间短,花费较少.临床试验注册中国临床试验中心,ChiCTR-OOC-15005889.

abstractsObjective To compare the advantage and disadvantage of peroral endoscopic myotomy (POEM)and pneumatic dilation(PD)for the treatment of achalasia of cardia(AC). Methods Patients with confirmed AC undergoing endoscopic therapy in Southwest Hospital, Third Military Medical University between January 2011 and September 2014 were divided into POEM treatment group(n=56)and PD treatment group(n = 30), according to the decision of the patients and their families. Postoperative improvement of clinical symptoms, changes in the maximum esophageal diameter, complications, hospital stay,and inpatient expenses were compared between the two groups. Results No significant differences were observed in general preoperative data between the two groups,including gender,age,body mass index (BMI),maximum esophageal diameter, Eckardt score and disease duration(all P>0.05). The Eckardt score showed a significant decrease in 1, 6, and 12 months after operation compared to the pre?operation score in both groups(P<0.05). No matter 1 month or 6 months after operation, the Eckardt score had no significant difference between the two groups(P>0.05). Six months after operation, the response rate between the two groups was no significantly different[93%(52/56)VS 80%(24/30), χ2=0.115, P=0.076],but the maximum esophageal diameter of the POEM group was smaller than that of the PD group (25.39±7.12 mm VS 32.12±9.99 mm,t=3.612,P=0.001). Twelve months after operation,the Eckardt score of the POEM group was lower than that of the PD group(0.44±0.85 score VS 1.26±1.74 score,t=2.940,P= 0.004), and the response rate was higher in the POEM group[93%(52/56)VS 80%(24/30),χ2=0.115, P=0.076]. The incidence of pneumatic complications was 32%(18/56)in the POEM group,but none occurred in the PD group(χ2=12.195,P=0.000). The hospital stay of the POEM group and the PD group was 12.33±4.13 days and 6.50±2.28 days, respectively(W=616, P=0.000). The inpatient expense of the POEM group and the PD group was 8 013.283± 4 322.695 yuan, and 1 571.018±1 590.193 yuan,respectively(W=505,P=0.000).Conclusion Both POEM and PD showed good short?term efficacy for AC.POEM is more effective,and its treatment outcome lasts longer,whereas PD has more widely indications because it is easier to operate with less complications,shorter hospital stay,and lower costs.Trail registration Chinese clinical trial registry,ChiCTR?OOC?15005889.