经节段性POEM治疗贲门失弛缓症食管不对称：一项回顾性单中心研究的短期结局
Trans-segmental POEM in the Management of Esophageal Asymmetry in Achalasia: Short Outcomes from a Retrospective, Single-center Study.
文献信息
| PMID | 42846895 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Jintao Xiao |
| 作者单位 | Department of GastroenterologyXiangya Hospital Central South UniversityChangshaHunanChina. |
| 期刊 | Endoscopy international open |
| SCI 分区 | Q1 |
| IF | 2.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景与研究目的： 在一些贲门失弛缓症（AC）患者中观察到食管不对称，表现为功能性或结构性改变。本研究旨在报告单中心采用经节段性经口内镜下肌切开术（T-POEM）治疗AC食管不对称的经验。
患者与方法： 纳入22例伴有严重吞咽困难的贲门失弛缓症患者。采用Eckardt评分、高分辨率测压（HRM）、钡餐食管造影、CT、超声内镜（EUS）和内镜检查评估食管不对称和限制性节段。T-POEM针对迂曲节段、局限性肌层增厚区域和局限性限制性肌层节段进行靶向肌切开。本研究评估了T-POEM的技术可行性、安全性和观察到的短期结局。
结果： T-POEM在全部22例患者中技术成功（100%），平均手术时间为67分钟。3例患者（13.6%）发生了记录在案的围手术期不良事件：1例出现气胸伴发热，2例出现一过性胸骨后疼痛。所有3起事件均经保守治疗缓解，无一例需要内镜或外科干预或重症监护。临床成功定义为最近一次可用随访时Eckardt评分≤3，在全部22例患者中均观察到临床成功。在可用的短期随访期间，平均Eckardt评分从6.7降至1.3（P < 0.0001）。
结论： 在这项小型回顾性病例系列中，T-POEM技术可行，并且与部分复杂贲门失弛缓症伴明显食管不对称患者的短期症状改善相关。这些初步发现并未确立其优于现有POEM技术，需要在更大规模的前瞻性比较研究中加以证实。
英文摘要
Background and Study Aims Esophageal asymmetry has been observed in some patients with achalasia, presenting as functional or structural alterations. This study aims to report a single-center experience with the trans-segmental peroral endoscopic myotomy (T-POEM) procedure for the management of esophageal asymmetry in AC. Patients and Methods Twenty-two patients with achalasia and severe dysphagia were included. Esophageal asymmetry and restrictive segments were assessed using the Eckardt score, HRM, barium esophagography, CT, EUS, and endoscopy. T-POEM was performed with targeted myotomy of tortuous segments, areas of localized muscular thickening, and localized restrictive muscular segments. This study evaluated the technical feasibility, safety, and observed short-term outcomes of T-POEM. Results T-POEM was technically successful in all 22 patients (100%), with a mean procedure time of 67 min. Three patients (13.6%) experienced documented periprocedural adverse events: one developed pneumothorax with fever, and two experienced transient retrosternal pain. All three events resolved with conservative treatment, and no event required endoscopic or surgical intervention or intensive care. Clinical success, defined as an Eckardt score ≤3 at the latest available follow-up, was observed in all 22 patients. The mean Eckardt score decreased from 6.7 to 1.3 ( P < 0.0001) during the available short-term follow-up. Conclusion In this small retrospective case series, T-POEM was technically feasible and was associated with short-term symptom improvement in selected patients with complex achalasia and marked esophageal asymmetry. These preliminary findings do not establish superiority over existing POEM techniques and require confirmation in larger prospective comparative studies.