經(jīng)口內(nèi)鏡肌切開術(shù)（POEM）與腹腔鏡Heller肌切開術(shù)（LHM）

對75例III型賁門失弛緩癥的治療一項多中心比較研究KumbhariViveketal.POEMvsLHMtreatmentforachalasia…EndoscIntOpen2015;03:E195–E201Peroralendoscopicmyotomy(POEM)vslaparoscopicHellermyotomy(LHM)forthetreatmentofTypeIIIachalasiain75patients:amulticentercomparativestudy

KumbhariViveketal.POEMvsLHMtreatmentforachalasia…EndoscIntOpen2015;03:E195–E2012023/2/1laparoscopicHellermyotomy(LHM)2023/2/1

goldstandard內(nèi)鏡下球囊擴張法2023/2/1Peroralendoscopicmyotomy(POEM)Firstdescribedinaporcinemodelin2007morethan5000clinicalprocedureshavebeenperformedinseveralcentersacrosstheworld

InitialclinicaldatafromEurope,Asia,andUnitedStateshasdemonstratedtheeffectivenessandsafetyofthisprocedurewhenperformedbyexperiencedendoscopists2023/2/1復(fù)旦大學(xué)附屬中山醫(yī)院在國內(nèi)率先成功開展POEM微創(chuàng)手術(shù)治療賁門失弛緩癥，至今完成2000多例，約占世界總量一半2023/2/1周平紅（2010）姚禮慶POEM2023/2/1BACKGROUNDAND

STUDY

AIMSTheoutcomesoftransabdominallaparoscopicHellermyotomy(LHM)fortypeIIIachalasiahasbeenreportedinsubgroupanalysisofachalasiastudieswithclinicalresponseratesof69.3%to86%。TheseoutcomesareinferiortoLHMforotherachalasiasubtypesasevidencedbyresponseratesfortypeIIof95%2023/2/1BACKGROUNDAND

STUDY

AIMSType

III

achalasia

ischaracterizedbyrapidlypropagatingpressurizationattributabletospasticcontractions.Although

laparoscopic

Heller

myotomy

(LHM)isthecurrentgoldstandardmanagementfor

type

III

achalasia,

Peroral

endoscopic

myotomy

(POEM)isconceivablysuperiorbecauseitallowsforalonger

myotomy.Ouraimsweretocomparetheefficacyandsafetyof

POEM

with

LHM

for

type

IIIachalasia

patients2023/2/1PATIENTS

ANDMETHODSAretrospective

study

of49

patients

whounderwent

POEM

for

type

III

achalasia

acrosseightcenterswerecomparedto26

patients

whounderwent

LHM

atasingleinstitution.(4US,3Asian,and1European)betweenJanuary2011andNovember2013wereincludedAugust2000andDecember2013atasingletertiaryUnitedStatesinstitution(JohnsHopkinsHospital)2023/2/1Flowdiagramdepictingthecriteria

usedtoincludepatientssuitableforanalysis2023/2/1Table2Baselinecharacteristicsofpatients

whounderwentperoralendoscopicmyotomyandlaparoscopicHellermyotomy2023/2/1PATIENTS

ANDMETHODS

Proceduraldatawereabstractedandpre-andpost-proceduralsymptomswererecorded.ClinicalresponsewasdefinedbyimprovementofsymptomsanddecreaseinEckardtstageto≤?1.?Secondaryoutcomesincludedlengthof

myotomy,procedureduration,lengthofhospitalstay,andrateofadverseevents.2023/2/12023/2/1Table1EckardtsymptomscoringandstagingRESULTS

Clinicalresponsewassignificantlymorefrequentinthe

POEM

cohort(98.0?%

vs

80.8?%;P?=?0.01).

POEM

patients

hadsignificantlyshortermeanproceduretimethan

LHM

patients

(102?min

vs

264min;P?<?0.01)despitelongerlengthof

myotomy

(16?cm

vs

8cm;P?<?0.01).2023/2/1RESULTS

Therewasnosignificantdifferencebetween

POEM

and

LHM

inthelengthofhospitalstay(3.3days

vs

3.2days;P?=?0.68),respectively.Rateofadverseeventswassignificantlylessinthe

POEM

group(6?%

vs

27?%;P?<?0.01).2023/2/1CONCLUSIONS

POEM

allowsforalonger

myotomy

than

LHM,whichmayresultinimprovedclinicaloutcomes.

POEM

appearstobeaneffectiveandsafealternativeto

LHM

in

patients

with

type

III

achalasia.2023/2/1limitationsofthisstudy2023/2/1limitationsofthisstudy2023/2/1themeanlengthoffollow-upintheLHMcohortwassubstantiallylongerat21.5monthscomparedto8.6monthsinthePOEMcohort,whichmayhavebiasedtheclinicalresponseinfavorofPOEM.I型被定義為在10次吞咽中，≥8次吞咽時遠(yuǎn)端食管內(nèi)壓力≤30mmHg；Ⅱ型的定義是在10次吞咽中，至少2次吞咽時食管內(nèi)壓力≥30mmHg；Ⅲ型定義為有2次或以上吞咽伴有痙攣性收縮