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目的:比较横开口法与纵开口法经口内镜下肌切开术(Peroral endoscopic myotomy,POEM)治疗贲门失弛缓症(Achalasia of cardia,AC)的效果与安全性,总结治疗体会。方法:2013年7月至2016年7月153例AC患者,按照POEM开口类型,将术中纵向切开食管右侧壁粘膜者纳入纵向组(n=69),术中横向切开粘膜者纳入横向组(n=84),比较两组患者手术情况、并发症发生情况、治疗效果及AC临床症状评分系统(Eckardt评分)变化,探讨两种开口方法的疗效与安全性,总结治疗体会。结果:横向组术中环形肌切开时间低于纵向组,其住院时间、住院费用也低于后者,差异有统计学意义(P<0.05)。纵向组并发症发生率为20.29%,高于横向组的7.25%,差异有统计学意义(P<0.05)。纵向组术后1个月有效率为94.20%,横向组为94.05%,两组效果比较,差异无统计学意义(P>0.05)。术前相比,两组患者术后Eckardt评分均逐渐降低,差异有统计学意义(P<0.05),同时期Eckardt评分组间比较,差异无统计学意义(P>0.05)。结论:POEM横向、纵向开口方式选择不影响疗效,横开口法术中环形肌切开时间更短、并发症发生率更低,在操作难度、安全性方面存在一定优势。
OBJECTIVE: To compare the efficacy and safety of transverse opening and peroral endoscopic myotomy (POEM) in the treatment of achalasia of cardia (AC) and to summarize the experience of treatment. Methods: From July 2013 to July 2016, 153 patients with AC were enrolled in the longitudinal group (n = 69) according to the type of POEM. Longitudinal incision was made in the longitudinal group (n = 69) (N = 84). The operative conditions, the incidence of complications, the effect of treatment and the score of AC clinical symptom score system (Eckardt score) were compared between the two groups. The curative effect and safety of the two methods of opening were compared. Results: In the lateral group, the open time of the ring muscle was lower than that of the longitudinal group, and the length of hospitalization and hospitalization were also lower than those of the longitudinal group. The difference was statistically significant (P <0.05). The incidence of complications in the longitudinal group was 20.29%, which was higher than that in the transverse group (7.25%), the difference was statistically significant (P <0.05). In the longitudinal group, the effective rate was 94.20% at one month and 94.05% in the lateral group. There was no significant difference between the two groups (P> 0.05). The Eckardt scores of the two groups of patients were significantly lower than those before operation (P <0.05). There was no significant difference between the two groups in Eckardt score (P> 0.05). CONCLUSION: The choice of lateral and longitudinal opening of POEM does not affect the curative effect. The transverse incision is shorter in the circumforamen opening and the complication rate is lower, which has some advantages in operation difficulty and safety.