POEM手术对不同压力分型AC患者治疗效果的分析

发布时间：2018-03-05 14:30

  本文选题：内镜下经口肌切开术　切入点：贲门失弛缓症　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过比较POEM(Peroral endoscopic myotomy,内镜下经口肌切开术)手术对不同压力分型AC(Achalasia,贲门失弛缓症)患者的食管功能参数和临床症状的影响,评价POEM术式对于不同类型AC患者治疗的疗效。方法:2014年10月至2016年10月就诊于我院消化科,并符合纳入标准者共20例,其中男10例,女10例,平均年龄为(47.25±13.40)岁,病程为(4.00±2.53)年,术前曾接受治疗干预者9例,未接受过治疗者11例,术前食道测压且参照芝加哥分类2014年V3.0示I型AC患者6例,II型AC患者14例。患者于入院后均行POEM手术,应用Eckardt(贲门失弛缓临床症状)评分法比较两组患者术前术后症状改善情况;通过HRM(Highresolution manometry,高分辨率食管测压)检测,比较两组患者术前术后LESP(Lower esophageal sphincter pressure,食管下括约肌压力)、LESL(Lower esophageal sphincter length,食管下括约肌长度)变化,获得并比对不同类型患者行POEM术式术后疗效及并发症发生情况。统计学分析使用SPSS19.0。结果:根据芝加哥分型示I型贲门失弛缓症者6例,男性4人,女性2人,既往接受口服药物治疗1例,平均年龄为(40.17± 13.17)岁,平均病程为(3.17± 1.94)年,平均住院天数为(10.00±2.10)天,平均手术时间为(60.67±27.32)分钟。II型贲门失弛缓症者14例,男性6人,女性8人,术前行口服药物治疗患者6例,行肉毒杆菌素治疗患者1例,行球囊扩张患者2例,平均年龄为(50.29±12.75)岁,平均病程为(4.36±2.74)年,平均住院天数为(11.57±2.77)天,平均手术时间为(67.86±20.11)分钟。I型、II型各基础资料(性别、年龄、病程、既往是否接受治疗)之间均无统计学差异(P0.05)。Ⅰ型Ⅱ型贲门失弛缓症患者对比,术中并发症(出血、黏膜层损伤、皮下气肿、气腹)、术后并发症(少量胸腔积液、感染发热、气胸、气腹、纵隔游离气体)与不良反应(上腹部疼痛、腹胀、胸闷气短),均无统计学差异(P0.05)。将两种分型AC患者行POEM手术,手术前后各参数进行对比,两种分型Eckardt评分比较,Ⅰ型术后较术前下降(4.83±0.75)分,Ⅱ型术后较术前下降(6.14±0.95)分,Ⅱ型症状改善程度较Ⅰ型明显,P=0.01;两种分型患者LESP参数比较,Ⅰ型术后较术前下降(10.62± 1.24),Ⅱ型术后较术前下降(12.94± 1.99),Ⅱ型压力降低程度较Ⅰ型更明显,P=0.02,两项差值比较均有统计学意义,P＜0.05。而两种分型LESL参数比较P=0.35,变化无统计学意义。结论:1.性别、年龄、病程、既往是否接受治疗对不同分型AC患者POEM手术成功率无明显影响。2.POEM术式治疗AC安全系数高,两种分型患者术中、术后并发症与不良反应均无明显差异。3.POEM术式对Ⅰ型和Ⅱ型AC患者均具有显著疗效,但是Ⅱ型患者术后Eckardt评分及HRM检测中LESP参数缓解程度更明显。
[Abstract]:Objective: to compare the effects of POEM(Peroral endoscopic myotomy (POEM(Peroral endoscopic myotomy) on esophageal function parameters and clinical symptoms in patients with Achalasia (achalasia) under different pressure types. Methods: from October 2014 to October 2016, 20 patients (10 males and 10 females) were admitted to our hospital from October 2014 to October 2016. The mean age was 47.25 卤13.40 years and the course of disease was 4.00 卤2.53 years. There were 9 patients who had received treatment intervention before operation, 11 patients who had not received treatment before operation, 14 patients with type I AC, 6 patients with type I AC according to Chicago classification V3.0 on 2014. All patients underwent POEM operation after admission. Eckardt score was used to compare the improvement of symptoms before and after operation between the two groups, and HRM(Highresolution manometry (high resolution esophageal manometry) was used. The changes of LESP(Lower esophageal sphincter pressure, lower esophageal sphincter pressure and lower esophageal sphincter length were compared between the two groups before and after operation. SPSS 19.00.Results: according to Chicago classification, 6 patients (4 males and 2 females) had achalasia of cardia type I, 4 males and 2 females. One patient received oral drug therapy with an average age of 40.17 卤13.17 years, an average course of disease of 3.17 卤1.94 years, an average hospital stay of 10.00 卤2.10 days, and an average operative time of 60.67 卤27.32 minutes for type II achalasia, 6 males and 8 females. Before operation, 6 patients were treated with oral drug therapy, 1 with Botox and 2 with balloon dilatation. The average age was 50.29 卤12.75 years, the average course of disease was 4.36 卤2.74 years, and the average hospital stay was 11.57 卤2.77 days. The average operative time was 67.86 卤20.11 minutes. There was no significant difference in the basic data (sex, age, course of disease, and whether or not received treatment) between the patients with type I type I and type 鈪，

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