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目的比较分析腹腔镜下Heller肌切开术与经口内镜下肌切开术(POEM)治疗贲门失弛缓症(AC)的疗效,为临床治疗选择提供依据。方法搜索知网、Embase、Pub Med等数据库中有关AC以及采用腹腔镜下Heller肌切开术与POEM治疗的相关文献,并对其中涉及到疗效及并发症的条目进行整理并进行综述。结果AC的治疗方式主要包括以腹腔镜下Heller肌切开术为主的外科治疗以及POEM为主的内镜治疗,这两种治疗术式的全面比较仍缺乏大量的相关数据,两种术式的选择仍存在争议。从目前已有的文献报道来看,无论从并发症、近期疗效等方面POEM均优于腹腔镜下Heller肌切开术,但其远期疗效比较仍不明确。结论腹腔镜下Heller肌切开术与POEM两种方式治疗AC均有效,POEM作为AC的一种较新的术式,体现了其创伤小、疗效确切,但其远期预后仍需要长期的随访研究。目前临床医生可根据患者AC的内镜下分型、患者自身体质、食管走行状况、既往治疗史,手术的耐受性等因素综合考虑选择合适的治疗方案。
Objective To compare and analyze the efficacy of laparoscopic Heller myotomy and POEM in the treatment of achalasia of achalasia (AC). Methods The databases of AC, Laparoscopic Heller myotomy and POEM were searched from databases such as Knapnet, Embase and Pub Med, and the articles concerning curative effect and complication were summarized and reviewed. Results The treatment of AC mainly included laparoscopic surgical treatment of Heller myotomy and POEM-based endoscopic treatment. The comprehensive comparison of these two kinds of surgical procedures lacks a large amount of relevant data. The two surgical procedures The choice is still controversial. From the current literature reports, no matter from the complications, the recent efficacy and other aspects of POEM are better than laparoscopic Heller myotomy, but its long-term efficacy is still not clear. Conclusions Laparoscopic Heller muscle incision and POEM are effective in both AC and AC. POEM is a relatively new type of AC, which shows small trauma and exact effect. However, its long-term prognosis still requires long-term follow-up the study. At present, clinicians can choose the appropriate treatment plan based on the endoscopic classification of patients with AC, the patient’s own constitution, esophageal walking status, previous treatment history, and surgical tolerance.