儿童贲门失弛缓症行POEM手术的临床效果与安全性探讨

Research Progress on Peroral Endoscopic Myotomy (POEM) in the Treatment of Achalasia in Children

摘要: 贲门失弛缓症(Achalasia Cardia, AC)是一种食管动力障碍性疾病，其特点是食管体平滑肌无效蠕动和食管下括约肌(Lower Esophageal Sphincter, LES)松弛障碍，患者主要表现为吞咽困难、食物反流及胸痛等症状，部分患者可伴有体重下降等表现。儿童的发病罕见，年均发病率为(0.10~0.18)/10万，儿童AC主要临床表现为吞咽困难、餐后反食，以及一些非典型症状，如肺部感染、夜间咳嗽、误吸、喂养困难、生长发育迟缓等。在内镜手术技术不断革新的今天，应用于治疗贲门失弛缓症的经口内镜下肌切开术(Peroral Endoscopic Myotomy, POEM)能有效缓解症状，降低并发症发生率，可行性和安全性均较高。然而，尽管成人患者已广泛受益于这一技术，儿童患者群体的应用仍相对有限。本文就POEM治疗儿童AC的近远期疗效及安全性的研究进展作一概述。

Abstract: Achalasia cardia (AC) is a motility disorder of the esophagus characterized by the ineffective peristalsis of the esophageal body smooth muscle and the relaxation disorder of the lower esophageal sphincter (LES). Patients often exhibit difficulty swallowing, reflux, and chest pain, or may be accompanied by weight loss. The incidence in children is rare, with an annual incidence rate of (0.10~0.18) per 100,000. The main clinical manifestations of pediatric AC include difficulty swallowing, postprandial regurgitation, and some atypical symptoms such as respiratory infections, nocturnal cough, aspiration, feeding difficulties, and delayed growth and development. With the continuous innovation of endoscopic surgical techniques, Peroral Endoscopic Myotomy (POEM), applied for the treatment of achalasia cardia, can effectively alleviate symptoms with a low incidence of complications, and is highly feasible and safe. However, although adult patients have widely benefited from this technology, its application in the pediatric patient population remains relatively limited. This article provides an overview of the recent and long-term efficacy and safety of POEM in the treatment of pediatric AC.