摘要
目的观察贲门失弛缓症（AC）患者经口内镜下肌切开术（POEM）前后的食管动力改变，评价POEM对AC食管动力的影响。方法行POEM治疗的AC患者35例，分别于术前及术后1个月应用固态高分辨率食管测压（HRM）系统检测不同食团（5mL液体和2cm×2cm×2cm固体）的食管动力学，分析对比手术前后食管下括约肌（LES）及食管体部的各动力学参数变化。统计学处理采用t检验、非参数检验或单因素方差分析。结果35例患者POEM术前液体吞咽和固体吞咽的食管下括约肌静息压（LESP）分别为（28．94±18．70）mmHg（1mmHg=0．133kPa）和（26．41±11．57）mmHg，术后分别为（16．02±5．46）mmHg和（15．82±5．04）mmHg，差异均有统计学意义（t=4．338、4．726，P均〈0．01）。术前液体吞咽和固体吞咽的4S完整松弛压（IRP）分别为（27．18±14．63）mmHg和（28．46±11．15）mmHg，术后分别为（12．22±6．75）mmHg和（14．54±7．83）mmHg，差异均有统计学意义（t=5．902、5．436，P均〈0．01）。液体吞咽和固体吞咽的食团内压也较术前降低（t=5．075、2．944，P均〈0．01）；液体吞咽的食管下括约肌松弛率（LESRR）则比术前有所升高（t=-2．990，P〈0.01），固体吞咽的LESRR手术前后差异无统计学意义（t=-0．340，P〉0．05）。Ⅰ型和Ⅲ型患者的远端收缩积分（DCI）及远端波幅参数术前与术后相比，差异均无统计学意义（P均〉0.05），U型患者术后均降低（液体Z=-2．704、-2．489，P〈0．05；固体Z=-1．929、-0．747，P〉0．05）。术后有2例患者出现食管近端蠕动波，但食管体部仍无完整的蠕动性收缩。所有患者在POEM术后临床症状迅速缓解，症状评分与术前相比显著下降（0．86±1．19比8．16±1．84，t=20．605，P〈0．05）。结论POEM能有效缓解AC患者LES松弛障碍，在一定程度上改善食管体部蠕动功能，且疗效不受分型�
Objective To observe the changes of esophageal motility in patients with achalasia （AC） before and after peroral endoscopic myotomy （POEM） and to evaluate the effects of POEM on esophageal motility in AC. Methods A total of 35 patients with AC received POEM. The esophageal motility in response to different food swallows （5 mL liquid and 2cm×2cm×2cm solid food） was evaluated by high- resolution manometry （HRM） system before operation and one month after operation. The changes of parameters of esophageal body and lower esophageal sphincter （LES） were analyzed and compared before and after operation. The t-test, non-parametric test or single factor analysis of variance was performed for statistical analysis. Results Before POEM operation, lower esophageal sphincter pressure （LESP） of 35 patients in response to liquid swallows and solid swallows was （28.94 ± 18.70） mmHg （1 mmHg= 0. 133 kPa） and （26.41±11.57） mmHg, respectively; after operation it was （16.02±5.46） mmHg and （15.82±5. 04） mmHg, respectively; and the differences were statistically significant （t= 4. 338 and 4. 726, both P^0.01）. Before operation, 4 s integrated relax pressure （4 s IRP） during liquid swallows and solid swallows was （27. 18± 14. 63） mmHg and （28. 46 ±11. 15） mmHg, respectively; after operation it was （12.22±6. 75） mmHg and （14.54±7.83） mmHg, respectively; and the differences were statistically significant （t= 5. 902 and 5. 436, both P〈0. 01）. And after operation intra bolus pressure （IBP） of liquid swallows and solid swallows also decreased compared to that before operation （t =5. 075 and 2. 944, both P〈0. 01）. Lower esophageal sphincter relaxation rate （LESRR） during liquid swallows and solid swallows increased compared to that before operation （t=-2. 990, P〈0. 01; t= -0. 340, P〉0.05）. There was no difference in the distal contractile integral （DCI） and distal esophageal peristaltic amplitude in subtype Ⅰ and Ⅲ patients before
出处
《中华消化杂志》
CAS
CSCD
北大核心
2015年第10期649-653,共5页
Chinese Journal of Digestion
