POEM治疗贲门失弛缓症中气体相关并发症的治疗及预防

发布时间：2018-03-30 02:10

本文选题：贲门失弛缓症　切入点：POEM　出处：《浙江大学》2017年硕士论文

【摘要】：贲门失弛缓症是一种食管下端的动力障碍性疾病,又称为贲门痉挛[12]。POEM是经口内镜下食管肌切开术(peroral endoscopic myotomy)的缩写,日本学者Inoue[7]首次成功为临床病人实施手术,取得和外科手术等同的效果,后来在各个国家迅速发展,但并发症的发生率快速上升,有很多专家也专门对并发症进行过总结[23,24],其中有涉及气体相关并发症,气体相关并发症是由气体经隧道进入食管壁外的腔隙引起的,包括气胸、纵隔气肿、气腹及皮下气肿。目前对气体相关并发症的治疗和预防意见尚无总结性的意见。这里介绍一例POEM手术中并发气胸、气腹及纵隔气肿的病例,患者虽然术中情况危急,但是经过及时诊断和抢救,患者得到及时治疗,获得了良好的预后。作为一个麻醉医生,需要维护患者术中生命体征稳定,及时应对并发症的发生。通过回顾POEM手术治疗贲门失弛缓症的文献,对POEM术中出现气体并发症的病因、病理生理、诊断、治疗及预防进行了综述,全面学习遇到紧急情况时如何及时诊断及处理,以及根据自我理解提出预防措施。
[Abstract]:Achalasia is a disorder of the lower end of the esophagus. It is also called cardiac spasm [12] .Pom is the abbreviation of transoral endoscopic esophagotomy. Inoue [7], a Japanese scholar, successfully performed the operation on clinical patients for the first time. Achieving the same results as surgery, which later developed rapidly in various countries, but the incidence of complications rose rapidly, and many experts specialized in summing up complications [2324], which involved gas-related complications, Gas-related complications are caused by the passage of gas through the tunnel into the space outside the wall of the esophagus, including pneumothorax, mediastinal emphysema, Pneumoperitoneum and subcutaneous emphysema. At present, there is no conclusive opinion on the treatment and prevention of gas-related complications. Here is a case of pneumothorax, pneumoperitoneum and mediastinal emphysema during POEM surgery, although the patient is in critical condition during the operation. However, after timely diagnosis and rescue, the patients received timely treatment and obtained a good prognosis. As an anesthesiologist, it is necessary to maintain the stability of the patient's vital signs during the operation. The causes, pathophysiology, diagnosis, treatment and prevention of gas complications in POEM were reviewed by reviewing the literature on the treatment of achalasia by POEM operation. Learn how to diagnose and deal with emergencies in time, and propose preventive measures based on self-understanding.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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