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1、經(jīng)口內(nèi)鏡下肌切開(kāi)術(shù)治療賁門(mén)失弛緩癥：45例報(bào)告發(fā)布日期：2011-6-2213:09:42作者:周平紅姚禮慶蔡明琰鐘蕓詩(shī)任重徐美東陳巍峰秦新?！菊磕康奶絠、J?經(jīng)口閃鏡下肌切開(kāi)術(shù)(POEM)治療賁門(mén)失弛緩癥(AC)的療效和可行性。方法回顧性研究2010年8W至2011年4月確診為AC井接受POEM治療的45例患者的臨床資料。POEM的主要步驟乜括：食管黏膜層切開(kāi)；分離黏膜下層，建立黏膜下“隧道”；胃鏡直視F切開(kāi)環(huán)形??；金屬火關(guān)閉黏膜層切U。結(jié)果所有45例患者均成功接受POEM術(shù)，平均年齡43.9歲(10-
2、70)，平均病程8.7y(3m-50y)，平均平術(shù)時(shí)間68.5min(23-180)，黏膜下隧道平均氏度10.5cm(8-15)，環(huán)形肌切開(kāi)平均長(zhǎng)度9.5cm(7-13),無(wú)1例岀現(xiàn)勾POEM相關(guān)的嚴(yán)重并發(fā)癥。術(shù)后隨訪，44例吞咽W難明砧將到解除；丨例術(shù)后15d出現(xiàn)進(jìn)食W難及嘔吐，胃鏡檢查發(fā)現(xiàn)黏膜K竇道形成，行內(nèi)鏡下竇道切開(kāi)。平均隨訪時(shí)間2.5m(1-6)。結(jié)論作為一種新的微創(chuàng)治療方法，POEM治療AC短期療效肯定，可以迅速解除AC患者吞咽W難，似其長(zhǎng)期療效及遠(yuǎn)期并發(fā)癥仍有待隨訪和觀察。【關(guān)鍵詞】賁門(mén)失弛緩癥
3、內(nèi)鏡肌切開(kāi)術(shù)Peroralendoscopicmyotomy(POEM)foresophagealachalasia:34casesreportZHOUPinghong,YAOLiqing,CAIMingyan，ZHONGYunshi,RenZhong，XUMeidong，CHENWcifcng,QINXinyu.EndoscopyCenter，ZhongshanHospital，F(xiàn)udanUniversity,Sahnghai200032,ChinaCorrespondingauthor:YAOLiqing
4、,Email:zhou1968@yahoo.cn[Abstract]ObjectiveToevaluatetheefficacyandthefesibilityofperoralendoscopicmyotomy(POEM)foresophagealachalasia(AC).PatientsandmethodsTheclinicaldataof34patientsdiagnosedasACandreceivedPOEMwerereviewedretrospectivelyinourcenterduringA
5、ugust2010andApril2011.ThekeyproceduresofPOEMwereasfollowing,1)esophagealmucosalincision，2)submucosal“tunnelling”byendoscopicsubmucosaldissection(ESD)technique,3)endoscopicmyotomyofthecircularmuscle，4)closureofmucosalentrybyhemostaticclips.ResultsAll45patien
6、tsreceivedPOEMsuccessfully.Theaverageagewas43.9years(range10-70).Theaveragedurationofsymptomswere8.7years(range3m-50y).Themeanoperationtimewas68.5min(range23-180)withameansubmucosaltunnellinglengthof10.5cm(range8-15).Theaveragelengthofendoscopicmyotomyofinn
7、ercircularmusclewas9.5cm(range7-13).NoseriouscomplicatiosrelatedtoPOEMwereencountered.Dysphagiasymptomwasrelievedsignificantlyduringthefollow-upperiodin44patients;onepatientre-occurreddysphagiaandvomiting15daysaftertheoperation，endoscopicobservationrevealin
8、gasubmucosalfistulawhichwasmanagedbyendoscopicincision.Themeanfollow-upperiodwas2.5m(range1-6).ConclusionAsanewminimallyinvasivetherapyforAC，POEMseemstobeveryeffectivetorelievepatient’sdysphagiasymptom
