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.ppt

经口内镜肌切开组临床反应率显著高于腹腔镜组（98.0?%?vs?80.8?%; P?=?0.01），需更短的手术时间(102?min?vs?264 min; P??0.01)，却能达到更长的肌切开长度(16?cm?vs?8 cm; P??0.01). * 住院时间无差别(3.3 days?vs?3.2 days; P?=?0.68)，不良事件发生率经口内镜肌切除组显著减少(6?%?vs?27?%; P??0.01) * 经口内镜肌切开术比腹腔镜组可达到更长的肌切开长度，从而提高临床疗效。?对于III型贲门失迟缓症患者来说，它似乎是一种比腹腔镜下贲门括约肌切开术更安全有效的选择。 * 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: E195–E201 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: E195–E201 * laparoscopic Heller myotomy (LHM) * gold standard 内镜下球囊扩张法 * 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 * 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 * 周平红（2010） 姚礼庆 POEM * BACKGROUND AND?STUDY?AIMS 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% * BACKGROUND AND?STUDY?AIMS Type?III?achalasia?is characterized by rapidly propagating pressurization attributable to spastic contractions. Although?laparoscopic?Heller?myotomy?(LHM) is the current gold standard management for?type?III?achalasia,? Peroral?endoscopic?myotomy?(POEM) is conceivably superior because it allows for a longer?myotomy. Our aims were to compare the efficacy and safety of?POEM?with?LHM?for?type?IIIachalasia?patients * PATIENTS?AND