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目的探讨贲门失弛缓症患者经口内镜下肌切开术(POEM)前后食管动力学变化。方法回顾性分析解放军总医院消化内科2010年12月至2014年9月行POEM术的贲门失弛缓患者205例,其中共66例患者术前及术后食管测压检查完善,包括上食管括约肌静息压(UESP)、残余压(UESRP),下食管扩约肌静息压(LESP)、残余压(LESRP)、松弛率(LESRR),以及食管体部蠕动波,从而对POEM术与食管动力学的改善情况做以评估。对上述指标以x±s采集,采用SPSS 16.0统计软件行配对t检验。结果贲门失弛缓患者行POEM术后症状短期缓解率为95%,术后UESRP(16.468±21.672 vs 8.982±7.601,P=0.008)、LESP(34.678±14.908 vs 16.612±8.671,P=0.000)、LESRP(27.459±10.719 vs 11.313±6.792,P=0.000)较术前明显降低,LESRR较术前明显提高(0.211±0.146 vs 0.297±0.224,P=0.008)。但是POEM术对食管体部正常蠕动波无明确改善。结论 POEM术可有效降低贲门失弛缓患者上食管括约肌(UES)和下食管括约肌(LES)的压力,从而缓解临床症状,其远期效果及最终结论仍需进一步研究。
Objective To investigate the changes of esophageal motility in patients with achalasia undergoing endoscopic musculotomy (POEM). Methods A retrospective analysis of PLA General Hospital Department of Gastroenterology from December 2010 to September 2014 POEM operation in patients with achalasia in 205 cases, of which a total of 66 patients with preoperative and postoperative esophageal manometry improved, including the upper gastrointestinal sphincter of static UESP, UESRP, LESP, LESRR, and peristalsis of the esophageal body were measured to evaluate the relationship between POEM and esophageal motility Learning to improve the situation to do assessment. The above indicators to x ± s acquisition, using SPSS 16.0 statistical software paired t test. Results After the POEM operation, the short-term remission rate was 95%. The postoperative UESRP scores were 16.468 ± 21.672 vs 8.982 ± 7.601, P = 0.008, LESP (34.678 ± 14.908 vs 16.612 ± 8.671, P = 0.000) (27.459 ± 10.719 vs 11.313 ± 6.792, P = 0.000). The LESRR was significantly higher than that before operation (0.211 ± 0.146 vs 0.297 ± 0.224, P = 0.008). However, POEM surgery on the esophageal normal peristalsis waves did not improve significantly. Conclusion POEM can effectively reduce the pressure on esophageal sphincter (UES) and lower esophageal sphincter (LES) in patients with achalasia and relieve the clinical symptoms. The long-term results and the final conclusions still need further study.