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贲门失弛缓症的治疗目的为降低下食管括约肌压力(LESP),减轻梗阻,改善临床症状。经口内镜下肌切开术(POEM)近年来开始用于贲门失弛缓症的治疗。目的:通过分析手术前后食管动力的变化,评估POEM治疗贲门失弛缓症的近期疗效。方法:纳入2011年12月~2012年10月在南京鼓楼医院诊断为贲门失弛缓症并接受POEM治疗的39例患者,对其手术前后食管液态测压和近期随访结果进行回顾性分析。结果:38例患者完成POEM和术后3 d食管测压。术后3 d LESP较术前显著降低(P0.01),LES松弛率与术前相比无明显差异。术前和术后3 d食管体部均表现为蠕动性收缩消失,同步收缩比例增加。术后1个月随访,LESP仍显著低于术前(P0.05),37例患者吞咽困难明显好转,有效率为94.9%。结论:POEM治疗贲门失弛缓症近期内降低LESP和缓解临床症状效果明显,但对恢复食管蠕动功能作用有限。食管测压对贲门失弛缓症术后疗效评估有一定价值。  相似文献   

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Peroral endoscopic myotomy (POEM) has emerged as a rescue treatment for recurrent or persistent achalasia after failed initial management. Therefore, we aimed to investigate the efficacy and safety of POEM in achalasia patients with failed previous intervention. We searched the MEDLINE, Embase, Cochrane, and PubMed databases using the queries “achalasia,” “peroral endoscopic myotomy,” and related terms in March 2019. Data on technical and clinical success, adverse events, Eckardt score and lower esophageal sphincter (LES) pressure were collected. The pooled event rates, mean differences (MDs) and risk ratios (RR) were calculated. A total of 15 studies with 2,276 achalasia patients were included. Overall, the pooled technical success, clinical success and adverse events rate of rescue POEM were 98.0% (95% confidence interval [CI], 96.6% to 98.8%), 90.8% (95% CI, 88.8% to 92.4%) and 10.3% (95% CI, 6.6% to 15.8%), respectively. Seven studies compared the clinical outcomes of POEM between previous failed treatment and the treatment naïve patients. The RR for technical success, clinical success, and adverse events were 1.00 (95% CI, 0.98 to 1.01), 0.98 (95% CI, 0.92 to 1.04), and 1.17 (95% CI, 0.78 to 1.76), respectively. Overall, there was significant reduction in the pre- and post-Eckardt score (MD, 5.77; p<0.001) and LES pressure (MD, 18.3 mm Hg; p<0.001) for achalasia patients with failed previous intervention after POEM. POEM appears to be a safe, effective and feasible treatment for individuals who have undergone previous failed intervention. It has similar outcomes in previously treated and treatment-naïve achalasia patients.  相似文献   

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Background/Aims: Patients with achalasia have a high incidence of esophageal squamous cell carcinoma (ESCC), which may be associated with alterations in oral and esophageal microbiota caused by food stasis. This study compared the oral and esophageal microbiota of patients with achalasia before and after peroral endoscopic myotomy (POEM). It also compared patients with achalasia to those with ESCC.Materials and Methods: The study prospectively examined 6 patients with achalasia and 14 with superficial ESCC. Oral samples obtained from the buccal mucosa using a swab and esophageal samples obtained from the mid-esophagus using a brush via endoscopy were analyzed by 16S rRNA metagenome sequencing. Additionally, endoscopic and histological findings of patients with achalasia before and after POEM were prospectively compared.Results: In patients with achalasia, Streptococcus was most abundant in both the oral and the esophageal microbiota, and these microbiota were significantly different. Although the overall structure of the oral and esophageal microbiota did not change after POEM, the relative abundance rate of Haemophilus and Neisseria increased in the esophagus, and endoscopic findings of inflammation improved after POEM (P = .04). The relative abundance of microbiota was not different among patients with achalasia from those with ESCC. Conclusions: The oral and esophageal microbiota were significantly different in patients with achalasia, and some of the composition of the esophageal microbiota changed after POEM. However, these findings and disease-specific microbiota should be further evaluated in large-scale studies.  相似文献   

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We aimed to assess the short-term outcomes of per-oral endoscopic myotomy (POEM) compared with laparoscopic Heller myotomy (LHM) for achalasia through a meta-analysis of nonrandomized comparative studies.We searched PubMed, Embase, Medline, Cochrane Library, and Google Scholar for studies that compared POEM and LHM for achalasia and were published between January 1, 2008 and December 31, 2014. The Methodological Index for Nonrandomized Studies (MINORS) was used to evaluate the quality of the studies. Random- and fixed-effects meta-analytical models were used, and between-study heterogeneity was assessed.Four nonrandomized comparative studies that included 317 patients (125 in the POEM group and 192 in the LHM group) met our research criteria and were assessed. There were no differences between the POEM and LHM groups in terms of sex, preoperative Eckhart score, length of myotomy, operation time, length of hospital stay, and complications. The patients in the POEM group were older than those in the LHM group (MD =2.81, 95% CI 0.27–5.35; P = 0.03) with high between-study homogeneity (χ2 = 1.96, df = 2, I2 = 0%; P = 0.38). The patients in the POEM group had a lower Eckardt score after surgery compared with those in the LHM group (MD = −0.30, 95% CI −0.42 to −0.18; P < 0.001) with high between-study homogeneity (χ2 = 0.00, df = 1, I2 = 0%; P = 1.00).The efficacy and safety of POEM appear to be comparable to those of LHM. Multicenter and randomized trials with larger sample size are needed to further compare the efficacy and safety of POEM and LHM for the treatment of achalasia.  相似文献   

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Background Published data on the accuracy of endoscopic ultrasound (EUS) for staging distant and celiac axis lymph node (CLN) metastasis in patients with esophageal cancer (ECA) has varied. Aim To evaluate the accuracy of EUS in diagnosing distal and CLN metastasis in ECA patients. Method Study selection: EUS studies confirmed by surgery were selected. Statistical method: Pooling was conducted by both fixed and random-effects models. Results Data were extracted from 25 studies (N = 2029) which met the inclusion criteria. In ECA patients, pooled sensitivity of EUS was 67.2% (95% CI: 62.6-71.6) in diagnosis of distal metastasis and 66.6% (95% CI: 61.9-71.1) in diagnosis of CLN metastasis. EUS had a pooled specificity of 97.9% (95% CI: 97.1-98.6) for distal metastasis and 98.1% (95% CI: 97.3-98.7) for CLN metastasis. Conclusions Although EUS has excellent specificity in accurately diagnosing distal and CLN metastasis in patients with ECA, the sensitivity is low.  相似文献   

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Endoscopic resection (ER) has been widely accepted to treat early gastric cancer (EGC) in place of surgical resection (SR). The aim of this meta-analysis was to conduct a comprehensive comparison between the two methods.Four literature databases, including PubMed, Web of Science, the Cochrane Library, and EMBASE, were searched for studies that compared ER with SR to treat EGC. In this meta-analysis, primary and secondary endpoints were compared between the two groups. Primary endpoints included overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and recurrence-free survival (RFS). Secondary endpoints included operation-related death, local recurrence, metachronous lesions, procedure-related complication, bleeding, hospital stay, operation time, and cost.Nineteen studies consisting of a total of 6118 patients were identified and selected for evaluation. Meta-analysis showed that long-term outcomes of ER versus SR for EGC were comparable in terms of 5-year OS (risk ratio [RR] 1.00, 95% confidence interval [CI] 0.98–1.02), DSS (RR 0.98, 95% CI 0.89–1.08), DFS (RR 0.95, 95% CI 0.86–1.05), and RFS (RR 0.98, 95% CI 0.94–1.01). However, ER had shorter operation time (standardized mean difference [SMD] −3.39, 95% CI −3.58 to 3.20), hospital stay (SMD −2.86, 95% CI −4.02 to −1.69), lower costs (SMD −5.30, 95% CI −10.37 to −0.22), and fewer procedure-related complications (RR 0.43, 95% CI 0.28–0.65) compared to SR. Nevertheless, ER had higher incidences of local recurrence (risk difference 0.01, 95% CI 0.00–0.02) and metachronous lesions (RR 6.81, 95% CI 3.80–12.19).Endoscopic resection was associated with similar long-term outcomes and considerable advantages concerning operation time, hospital stay, costs, and complications, compared with SR, and was also associated with disadvantages such as higher incidence of local recurrence and metachronous lesions. Further high-quality studies from more countries are required to confirm these results.  相似文献   

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Digestive Diseases and Sciences - Chronic viral hepatitis is associated with a wide range of extrahepatic diseases; however, evidence on a link between chronic viral hepatitis and colorectal...  相似文献   

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