经口内镜下肌切开术治疗贲门失弛缓症近期疗效观察

发布时间：2018-04-11 23:05

本文选题：贲门失弛缓症 + 经口内镜下肌切开术　；参考：《广西医科大学》2014年硕士论文

【摘要】：目的：探讨经口内镜下肌切开术(peroral endoscopic myotomy, POEM)治疗贲门失弛症(achalasia of cardia, AC)的疗效和安全性,以及超声内镜在经口内镜下肌切开术治疗贲门失弛缓症中的应用价值。方法：采用前瞻性研究方法,纳入在广西医科大学第一附属医院确诊为贲门失弛缓症并接受POEM治疗的患者作为研究对象。于术前行Eckardt's评分,并行超声内镜检查,测贲门口、贲门上5cm、责门上10cm、贲门上15cm处固有肌层厚度。术中记录黏膜下隧道长度,固有肌层切开长度、深度,以及并发症情况。术后进行随访,术后3个月、6个月行Eckardt's评分。结果：2013年5月至2013年12月共入选24例诊断为贲门失弛缓症并接受POEM治疗的患者,其平均年龄41.88±10.85岁。责门口、贲门上5cm、贲门上10cm、贲门上15cm固有肌层厚度分别为：3.01±0.63mm,2.34±0.45mm,1.99±0.34mm,1.49±0.34mm。24名患者术前Eckardt's评分为6.50±1.35。Spearman秩相关分析显示贲门处固有肌层厚度与Eckardt's评分存在正相关性(r=0.519,P=0.039),与患者病程不存在相关性(r=0.145,P=0.591)。全组患者均顺利完成POEM术,手术时间90～240min,黏膜下隧道长度8-12cm,肌切开长度6～10cm,未出现手术相关严重并发症及死亡。术后成功电话随访24例患者,随访时间3-10个月,24例患者术后3个月Eckardt's评分的为1.04±0.96,较术前明显降低(P0.05)。其中11名患者术后6个月Eckardt's评分为1.00±0.78,与术前的6.73±1.56相比下降明显(P0.05),与术后3个月的Eckardt's评分相比较差异无统计学差异(P0.05)。结论：1.贲门失弛缓症患者贲门口处固有肌层厚度与患者吞咽困难严重程度正相关,与病程长短无相关性；2. POEM可以迅速解除贲门失弛缓症患者吞咽困难症状,短期疗效肯定,安全性好,但其长期疗效及远期并发症仍有待随访和观察。3.AC患者POEM术前行超声内镜检查对手术的进行有一定的指导意义。
[Abstract]:Objective: to evaluate the efficacy and safety of peroral endoscopic myotomy (poemma) in the treatment of cardia achalasia of cardiac achalasia (ACC), and the value of EUS in the treatment of achalasia.Methods: prospective study was carried out in patients with achalasia diagnosed in the first affiliated Hospital of Guangxi Medical University and treated with POEM.Eckardt's score was performed before operation, and endoscopic ultrasonography was performed. The cardiac orifice, 5 cm above the cardia and 10 cm above the fundus were measured, and the thickness of the lamina propria muscularis propria on the 15cm on the cardia was measured.The length of the submucous tunnel, the length and depth of the incision of the lamina propria, and the complications were recorded during the operation.Follow-up, 3 months, 6 months after the Eckardt's score.Results: from May 2013 to December 2013, 24 patients with achalasia diagnosed and treated with POEM were enrolled, with an average age of 41.88 卤10.85 years.POEM was performed successfully in all patients. The operative time was 90 ~ 240 min, the length of submucosal tunnel was 8 ~ 12 cm, and the length of muscle incision was 6 ~ 10 cm. There were no severe complications and death associated with the operation.24 patients were followed up by telephone successfully. The Eckardt's score of 24 patients 3 to 10 months after operation was 1.04 卤0.96, which was significantly lower than that before operation.The Eckardt's score of 11 patients was 1.00 卤0.78 at 6 months after operation, which was significantly lower than that before operation (6.73 卤1.56). There was no significant difference in Eckardt's score between 11 patients and 3 months postoperatively (P 0.05).Conclusion 1.The thickness of the lamina propria muscularis in patients with achalasia was positively correlated with the severity of dysphagia, but not with the duration of the disease.POEM can quickly relieve dysphagia in patients with achalasia.However, the long-term curative effect and long-term complications still need to be followed up and observed. 3. EUS endoscopic examination before POEM has certain guiding significance for the operation.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R571

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