经口内镜肌切开术治疗贲门失弛缓症的临床疗效及生存质量评价

发布时间：2018-04-12 17:36

本文选题：贲门失弛缓症 + 经口内镜肌切开术(POEM)　；参考：《中南大学》2014年硕士论文

【摘要】：背景：随着医学模式向生物-心理-社会医学模式转变,医学治疗的对象不仅仅是患者的躯体,还包括疾病及其治疗方法造成的患者精力、心理、社会职能及情感等方面的健康问题,因此通过评价健康相关生存质量来全面评价疾病及治疗对患者造成的生理、心理和社会生活等方面的影响很重要。贲门失弛缓症是一种慢性进展性疾病,病人通常需要花大量时间、金钱、精力用于疾病治疗,严重影响患者的社会心理功能,使患者的健康相关生存质量下降。目前国外有少量关于球囊扩张术、Heller术术后贲门失弛缓症患者生存质量改善的研究,提示这些治疗方法能显著改善患者的生存质量。POEM术是贲门失弛缓症的一种较新的治疗方法,该方法综合内镜和外科手术的特点,目前国外罕见POEM术对贲门失驰缓症患者生存质量影响的研究,尤其国内在这方面更是空白。因此,本研究旨在探讨POEM术对贲门失弛缓症患者疗效及生存质量的影响。目的：评价经口内镜肌切开术治疗贲门失弛缓症的疗效及生存质量。方法：对35例贲门失驰缓症患者采用经口内镜下肌切开术治疗,应用Eckardt症状评分、胃镜及钡餐检查等资料对患者临床疗效进行评价。同时使用36条目简明量表(SF-36)进行调查评价患者生存质量情况。结果：35例患者均成功接受POEM术治疗,手术成功率为100%,平均操作时间为55分钟。隧道长度平均14.1cm,肌切开长度平均10.6cm。术后1月、6月Eckardt症状评分均较术前明显降低(0.51vs6.83,0.45vs6.83,均P0.05),食管平均直径较术前显著缩小(32.00mm vs47.97mm,28.50mm vs47.97mm,均PO.05)；并发症发生率为14.3%(5/35),其中气肿发生率为8.6%(3/35),反流发生率为1.5%(1／35),顽固性呃逆发生率为1.5%(1/35)；平均随访6.4月,有效率达100%,随访期内无1例复发,复发率为0%。本组患者术前各维度生存质量平均得分均较常模降低,其中PF、BP、GH、RE4维度差异有统计学意义(P0.05)；术后1月和6月8维度生存质量平均得分均显著高于相应维度常模值(P0.05),8维度生存质量及生理领域、心理领域平均得分亦均较术前显著提高(P0.05),且其得分改善率与术前相应维度基础得分值均呈负相关(P0.05)；术后1月Eckardt症状评分与各维度生存质量得分均呈负相关,而术后6月Eckardt症状评分仅与BP、GH、SF、RE、MH5个维度和生理领域得分、心理领域得分均呈负相关(P0.05)；术后1月和6月随着年龄增大,生理领域生存质量得分越低(P0.05)。结论：1. POEM术是治疗贲门失弛缓症的一种安全有效的方法,短期内能显著改善患者临床症状及食管扩张的严重程度。2.贲门失弛缓症患者POEM术前生存质量低于一般人群,术后其生存质量显著提高,甚至高于一般人群;同时术后患者症状控制越好,其生存质量越高；术前生存质量越差的患者,术后生存质量改善程度越大；术后生理领域生存质量随患者年龄增大而降低。
[Abstract]:Background: as the medical model changes to the biological, psycho-social medical model, medical treatment not only targets the patient's body, but also includes the patient's energy and psychology caused by the disease and its treatment.Therefore, it is very important to evaluate the physical, psychological and social effects of disease and treatment on patients by evaluating health-related quality of life.Achalasia is a chronic progressive disease. Patients usually spend a lot of time, money and energy on the treatment of the disease.At present, there are a few studies on the improvement of quality of life in patients with achalasia after Heller's balloon dilatation, suggesting that these treatments can significantly improve the quality of life of patients with achalasia.This method synthesizes the characteristics of endoscopy and surgery. At present, the effect of rare POEM surgery on the quality of life of patients with cardia loss is studied, especially in China.Therefore, the purpose of this study was to investigate the effect of POEM on the efficacy and quality of life of achalasia patients.Objective: to evaluate the efficacy and quality of life of endoscopic myotomy in the treatment of achalasia.Methods: 35 patients with cardia achalasia were treated by endoscopic myotomy. The clinical efficacy was evaluated by Eckardt symptom score, gastroscopy and barium meal examination.At the same time, SF-36 was used to investigate and evaluate the quality of life (QOL) of patients.Results all 35 cases were successfully treated with POEM. The successful rate of operation was 100 and the average operation time was 55 minutes.The average length of tunnel was 14.1 cm, and the length of muscle incision was 10.6 cm.The birth rate was 1.5 / 35. The average follow-up was 6.4 months.The effective rate was 100 and there was no recurrence during the follow-up period, and the recurrence rate was 0.The mean scores of quality of life in all dimensions of the patients were lower than those of the norm before operation.Among them, there were significant differences in the dimension of RE4 between PFN and BPG, and the mean scores of QOL in the 8th dimension after operation were significantly higher than those in the corresponding dimension norm (P0.05 / 8), and in the physiological field, there was no significant difference in the quality of life (QOL) and physiological field (P 0.05).The average score in psychological field was significantly higher than that before operation (P 0.05), and the improvement rate of the score was negatively correlated with the score of preoperative dimension basis, and the score of Eckardt symptom was negatively correlated with the score of quality of life of each dimension at 1 month after operation.At 6 months after operation, the scores of Eckardt symptoms were only correlated with the scores of 5 dimensions and physiological domains, and the scores of psychological domain were negatively correlated with the scores of P0.05. the scores of quality of life in physiological domains were lower with the increase of age in the first and sixth months after operation (P 0.05).Conclusion 1.POEM is a safe and effective method for the treatment of achalasia. In the short term, it can significantly improve the clinical symptoms and the severity of esophageal dilatation.The quality of life of the patients with achalasia before operation was lower than that of the general population, and the quality of life after operation was significantly improved, even higher than that of the general population. At the same time, the better the symptom control was, the higher the quality of life was; the worse the quality of life was before operation, the better the quality of life was.The better the quality of life after operation, the lower the quality of life in physiological field with the age of patients.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R571

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