经口内镜肌切开术POEM与腹腔镜肌切开术(LHM)对75例III型贲门失弛缓症的治疗一项多中心比较研究

经口内镜肌切开术（POEM） 与腹腔镜Heller肌切开术（LHM） 对75例III型贲门失弛缓症的治疗一项多中心比较研究,Kumbhari Vivek et al. POEM vs LHM treatment for achalasia Endosc Int Open 2015; 03: E195E201,Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study,Kumbhari Vivek et al. POEM vs LHM treatment for achalasia Endosc Int Open 2015; 03: E195E201,2017/12/5,laparoscopic Heller myotomy (LHM),2017/12/5,gold standard,内镜下球囊扩张法,2017/12/5,Peroral endoscopic myotomy (POEM),First described in a porcine model in 2007 more than 5000 clinical procedures have been performed in several centers across the world Initial clinical data from Europe, Asia, and United States has demonstrated the effectiveness and safety of this procedure when performed by experienced endoscopists,2017/12/5,复旦大学附属中山医院在国内率先成功开展POEM微创手术治疗贲门失弛缓症，至今完成2000多例， 约占世界总量一半,2017/12/5,周平红（2010）,姚礼庆,POEM,2017/12/5,BACKGROUND ANDSTUDYAIMS,The outcomes of transabdominal laparoscopic Heller myotomy (LHM) for type III achalasia has been reported in subgroup analysis of achalasia studies with clinical response rates of 69.3% to 86% 。 These outcomes are inferior to LHM for other achalasia subtypes as evidenced by response rates for type II of 95%,2017/12/5,BACKGROUND ANDSTUDYAIMS,TypeIIIachalasiais characterized by rapidly propagating pressurization attributable to spastic contractions.AlthoughlaparoscopicHellermyotomy(LHM) is the current gold standard management fortypeIIIachalasia,Peroralendoscopicmyotomy(POEM) is conceivably superior because it allows for a longermyotomy. Our aims were to compare the efficacy and safety ofPOEMwithLHMfortypeIIIachalasiapatients,2017/12/5,PATIENTSAND METHODS,A retrospectivestudyof 49patientswho underwentPOEMfortypeIIIachalasiaacross eight centers were compared to 26patientswho underwentLHMat a single institution. (4US,3 Asian,and 1 European) between January 2011 and November 2013 were includedAugust 2000 and December2013 at a singletertiary United States institution (Johns Hopkins Hospital),2017/12/5,Flow diagram depicting the criteria used to include patients suitable for analysis,2017/12/5,Table2 Baseline characteristics of patients who underwent peroral endoscopic myotomy and laparoscopic Heller myotomy,2017/12/5,PATIENTSAND METHODS,Procedural data were abstracted and pre- and post-procedural symptoms were recorded. Clinical response was defined by improvement of symptoms and decrease in Eckardt stage to 1.Secondary outcomes included length ofmyotomy, procedure duration, length of hospital stay, and rate of adverse events.,2017/12/5,2017/12/5,Table1 Eckardt symptom scoring and staging,RESULTS,Clinical response was significantly more frequent in thePOEMcohort (98.0%vs80.8%; P=0.01).POEMpatientshad significantly shorter mean procedure time thanLHMpatients(102minvs264 min; P0.01) despite longer length ofmyotomy(16cmvs8 cm; P0.01).,2017/12/5,RESULTS,There was no significant difference betweenPOEMandLHMin the length of hospital stay (3.3 daysvs3.2 days; P=0.68), respectively. Rate of adverse events was significantly less in thePOEMgroup (6%vs27%; P0.01).,2017/12/5,CONCLUSIONS,POEMallows for a longermyotomythanLHM, which may result in improved clinical outcomes.POEMappears to be an effective and safe alternative toLHMinpatientswithtypeIIIachalasia.,2017/12/5,limitations of this study,2017/12/5,limitations of this study,2017/12/5,the mean length of follow-up in the LHM cohort was substantially longer at 21.5 months compared to 8.6 months in the POEM cohort,which may have biased the clinical response in favor of POEM.,I型被定义为在10次吞咽中，8次吞咽时远端食管内压力30 mmHg；型的定义是在10次吞咽中，至少2次吞咽时食管内压力30 mmHg；型定义为有2 次或以上吞