经口内镜下肌切开术治疗贲门失弛缓症的围术期护理

贲门失弛缓症( achalasia of cardia,AC)是一种原发性食管动力障碍性疾病,以食管下段括约肌( lower esophageal sphincter, LES)的松弛功能受损,食管蠕动波减少或消失,食管同步收缩为特征. 经口内镜下肌切开术( per-oral endoscopic myotomy, POEM)是目前贲门失弛缓症的主要治疗方式. 贲门失弛缓症患者的围术期护理对于POEM手术的成功具有重要意义,良好的围术期护理可以促进患者早日康复,提高患者的生活质量. 本文将对POEM治疗贲门失弛缓症的围术期护理作一综述.     

应用短刀头强力电凝行经口内镜食管下括约肌切开术治疗贲门失弛缓症的效果

目的 分析应用回缩Dual刀头强力电凝行经口内镜食管下括约肌切开术(POEM)治疗贲门失弛缓症(AC)的安全性及有效性.方法 分析2016年1月-2019年3月广州医科大学附属第一医院29例AC患者的临床资料,患者均接受POEM治疗,随访满24个月.记录手术操作时间、术中及术后并发症发生率和Eckardt评分.结果 平...     

经口内镜下肌切开术治疗贲门失弛缓症术后复发的危险因素

目的:分析经口内镜下肌切开术(peroral endoscopic myotomy,POEM)治疗贲门失弛缓症术后复发的相关危险因素。方法:回顾性分析2012年2月至2017年12月东部战区总医院消化内科86例诊断为贲门失弛缓症并接受POEM手术治疗患者的临床资料,采用单因素和多因素logistic回归分析的方法,分析POEM术后贲门失迟缓症复发的相关危险因素。结果:19例患者POEM术后出现复发,复发率为22.1%。单因素分析显示:病程、Chicago分型与POEM术后贲门失弛缓症复发相关(P<0.05)。Logistic回归分析显示:病程是POEM术后发生贲门失迟缓症复发的独立危险因素(OR=0.780,95%CI:0.624~0.975,P=0.029)。结论:病程、Chicago分型与POEM术后贲门失弛缓症复发密切相关,病程是POEM术后贲门失迟缓症复发的独立危险因素。     

高分辨率食管测压在经口内镜下肌切开术治疗贲门失弛缓症中的应用价值

目的 对贲门失弛缓症(AC)患者实施经口内镜下肌切开术(POEM),在术前术后行高分辨率食管测压(HRM),评估POEM手术的疗效,进一步探讨HRM在POEM治疗AC中的临床应用价值.方法 纳入2018年1月-2019年12月就诊于青岛大学附属烟台毓璜顶医院消化内科确诊为AC并行POEM术的患者26例,记录术前Ecka...     

经口内镜下肌切开术治疗贲门失弛缓症临床疗效和并发症的分析

目的探讨经口内镜下肌切开术(POEM)治疗贲门失弛缓症(AC)的临床疗效和并发症。方法对2013年1月-2015年1月该院消化内镜中心的38例AC患者进行POEM治疗,观察手术相关并发症和胃食管反流情况,并对比分析治疗前后贲门失弛缓症临床症状评分系统(ECKARDT)评分和食管下段括约肌(LES)压力变化。结果 38例均成功实施POEM手术,无1例出现与POEM相关的严重并发症,出血、气体相关并发症均保守治疗成功。术后随访时间10.4个月(9~12个月),所有患者症状缓解,ECKARDT评分平均分从术前的8.7分降至术后的1.2分(P0.01),食管括约肌压力明显降低,平均压从术前的(33.40±11.80)mm Hg下降至术后的(13.50±4.30)mm H(g P0.01),气体相关并发症6例(15.78%),食管反流总发生率为23.68%(9/38)。结论 POEM用于AC的治疗是安全、有效的,并且具有较好的远期疗效。     

再次经口内镜下肌切开术治疗贲门失弛缓症的疗效观察

目的 探讨初次经口内镜下肌切开术(POEM)治疗贲门失弛缓症(AC)失败后,再次POEM手术的可行性、有效性及安全性.方法 选择2018年2月-2020年8月郑州大学第一附属医院收治的10例初次POEM治疗失败再次接受POEM治疗的AC患者,观察手术成功率、手术时间、术后住院时间、并发症、住院费用以及随访情况等相关指标...     

经口内镜下肌切开术在儿童贲门失弛缓症中的应用

目的探讨经口内镜下肌切开术(POEM)治疗儿童贲门失弛缓症(AC)的临床疗效及并发症发生情况。方法回顾性分析该院2012年11月-2016年11月确诊AC并接受POEM治疗的17例患儿的临床表现、POEM手术过程及术后随访情况。结果 17例患儿均成功完成POEM,无严重并发症发生,手术时间(62.65±35.54)min;17例患儿术后随访12~36个月,手术前后AC临床症状评分(Eckardt评分)分别为5(4.0-6.0)和0(0.0-1.0)分,差异有统计学意义(P=0.000),临床症状明显缓解,体重减轻情况明显改善。结论 POEM治疗儿童AC安全性高,短期疗效确切,长期疗效及远期并发症有待大样本量的随访监测。     

经口内镜下肌切开术治疗贲门失迟缓症疗效观察(附3例报告)

[目的]探讨经口内镜下括约肌切开术(POEM)治疗贲门失弛缓症(AC)的疗效和可行性.[方法]回顾性分析2011年7月至2012年4月本院诊为AC并接受POEM治疗的3例患者的临床资料,总结术中、术后以及随访过程中并发症的发生及治疗情况.[结果]所有3例患者均成功接受POEM术,仅1例出现术后皮下气肿、气胸及气腹症,经积极对症、保守治疗后痊愈.术后随访2～3个月,3例患者吞咽困难得到明显缓解.[结论]POEM作为一种新的微创手术,治疗AC近期疗效肯定,可以迅速缓解AC患者吞咽困难,远期疗效有待进一步随访.     

经口内镜下肌切开术对贲门失弛缓症患者围术期心理状态及临床症状的影响

目的探讨经口内镜下肌切开术(POEM)对贲门失弛缓症(AC)患者围术期心理状态及临床症状的影响。方法我院收治57例AC患者,均行POEM治疗,比较手术前后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、ECKARDT症状评分及36项健康调查简表(SF-36)评分变化。结果所有患者均手术成功。患者术后SAS、SDS评分均较术前明显降低(P0. 05)。术后6个月,患者ECKARDT评分与术前比较差异有统计学意义,SF-36量表各维度评分均较术前明显增高(P 0. 05)。结论 AC患者行PEOM治疗能够显著改善患者心理状态及临床症状,提高生活质量。     

经口内镜下肌切开术治疗贲门失弛缓症的初步研究(附27例报告)

目的探讨经口内镜下肌切开术(POEM)治疗贲门失弛缓症(AC)的疗效。方法收集2014年5月-2016年3月遵义医学院附属医院消化内科收住入院的27例确诊为AC的患者,并实施POEM术,总结手术完成情况、手术前后临床症状、食管测压、术后并发症及随访过程等资料。结果 27例患者行POEM治疗的成功率为100.0%,1例患者发现皮下气肿,1例患者发现少量气胸,行POEM患者中随访症状较前明显改善,食管测压较前亦有显著变化(P0.05)。结论 POEM治疗AC的短期疗效肯定,术后能够明显缓解吞咽困难等症,但其长期疗效及远期并发症仍有待进一步随访和观察。     

热活检钳法与传统法经口内镜食管下括约肌切开术治疗贲门失弛缓症的疗效比较

目的 比较使用热活检钳的改良方法与使用三角刀的传统方法,在经口内镜食管下括约肌切开术（POEM）治疗贲门失弛缓症（AC）中的临床疗效。方法 前瞻性纳入2017年2月－2022年2月该院消化内科行POEM治疗的AC患者64例,随机分为热活检钳组和传统方法组,各32例,均行POEM。记录并比较两种手术方式的肌切开与隧道长度、术后住院时间、住院费用、手术时间和并发症发生情况。结果 两组患者均成功完成手术,两组患者手术肌切开长度、隧道长度、气体相关不良事件、住院时间、术后6个月胃食管反流率和术后3个月Eckardt评分比较,差异均无统计学意义（P > 0.05）;但术中出血、手术时间、住院费用和术后6个月Eckardt评分比较,差异均有统计学意义（P < 0.05）。结论 使用热活检钳法与传统法均能有效治疗AC,但热活检钳法能缩短手术时间,减少术中出血和住院费用,且长期疗效可能更显著,尤其适合在技术水平有限的临床机构中推广。     

One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy

Background and aimsPeroral endoscopic myotomy (POEM) is an established therapy for achalasia, but outcome evaluation has often been limited to Eckardt score (ES). The present study was aimed to improve knowledge about outcome evaluation and predictive outcome factors by performing a comprehensive objective evaluation of achalasia patients treated by POEM.MethodsThis single centre prospective study reports outcome data 12 months after POEM in treatment-naive achalasia patients. A predefined follow-up protocol included ES, high resolution manometry, 24-h pH measurement, upper endoscopy and timed barium esophagogram (TBE). Univariate and multivariate regression analyses were performed to analyze association between post-POEM variables and identify predictive factors for objective outcome.ResultsFifty patients were included with a drop-out rate of <5%. ES, lower oesophageal sphincter pressures, TBE heights and maximal oesophageal diameter were all reduced after POEM (p < .001), and 28% (13/47) of the patients had a positive 24-h pH registration. An oesophageal diameter >3 cm after POEM was associated with treatment failure assessed by ES (p = .04) and TBE (p = .03). Advanced achalasia stage (p = .02) and long symptom duration (p = .04) were identified as independent predictive factors for poor outcome assessed by TBE.ConclusionsThe present study confirms that POEM is an efficient therapy for achalasia. The comprehensive objective evaluation after POEM demonstrates that long symptom duration and major changes in oesophageal anatomy at diagnosis imply poor treatment outcome, and a post-POEM dilated oesophagus is associated with treatment failure.

Key messages

• Peroral endoscopic myotomy (POEM) is established as a safe and effective therapy for achalasia.
• Timed barium esophagogram offers objective variables that are valuable in treatment response evaluation.
• Advanced achalasia stage and long symptom duration are predictive factors for poor objective treatment response after POEM.

     

经口内镜下肌切开术治疗贲门失弛缓症的疗效分析（附30例报告）

目的观察分析经口内镜下肌切开术(POEM)治疗贲门失弛缓症(AC)的临床疗效。方法收集2013年3月-2017年6月实施POEM的30例AC患者,评估手术前后Eckardt评分,记录食管动力测压结果、体质指数(BMI),总结手术完成情况、术后并发症及随访过程等资料。结果 30例患者行POEM治疗成功率100.0%,3例患者发现皮下气肿,2例有轻微胸骨后不适,4例有术后发热,1例发生迟发的上消化道出血。术后Eckardt评分(1.1±0.6)分与术前(5.2±1.3)分对比明显降低(P0.05),术后BMI(22.6±2.9)kg/m~2与术前(19.2±1.8)kg/m~2相比较前增加(P0.05)。食管动力学指标中,食管下括约肌静息压(LESP)术后(18.2±9.5)mm Hg对比术前(46.7±15.8)mm Hg明显降低(P0.05),食管下括约肌完整松弛压(IRP)术后(10.5±2.5)mm Hg对比术前(22.8±8.3)mm Hg也明显下降(P0.05),食管下括约肌长度(LESL)术后(2.5±0.5)cm对比术前(2.9±0.8)cm明显缩短(P0.05)。食管上括约肌静息压(UESP)和食管上括约肌长度(UESL),手术前后差异均无统计学意义(P0.05)。结论 POEM是治疗AC的有效手段,其短期疗效确切,且安全性相对较高,部分食管动力学指标较前改善,但其远期并发症及有效性还需大样本进一步随访。     

经口内镜下肌切开术与经胸Heller术治疗贲门失弛缓症的临床疗效对比

目的对比分析贲门失弛缓患者经口内镜下肌切开术(POEM)与经胸食管贲门部黏膜外肌层切开手术(即Heller术)的临床疗效及安全性。方法回顾性研究2012年1月-2014年10月该院78例确诊为贲门失弛缓症患者。其中,接受POEM术患者为42例,接受Heller术患者36例,观察并对比两组患者术后症状缓解情况、食管下段括约肌(LES)静息压力、Eckardt评分、术中和术后并发症发生率、手术时长、住院时间及住院费用等。结果两组患者术后均获得明显的临床缓解,POEM组患者的并发症发生率、Eckardt评分及LES静息压力和Heller术组相比差异无统计学意义(P0.05)。而POEM组患者的手术耗时、住院时长及住院费用均明显低于Heller术组(P0.05)。结论 POEM作为一种近期疗效显著的内镜微创手术方式,与外科手术疗效相当,对患者造成的创伤小,痛苦小,使患者耐受性好,住院时间及住院费用减少,值得推广。     

经口内镜下肌切开术治疗贲门失弛缓症的护理配合体会

目的探讨经口内镜下肌切开术（POEM）治疗贲门失弛缓症（AC）护理配合技巧与安全性。方法研究2011年12月至2012年4月确诊AC并接受POEM治疗护理的8例患者的临床资料。POEM主要手术配合步骤;协助食管黏膜下注射;食管黏膜层切开;分离黏膜下层建立黏膜下“隧道”;内镜直视下纵行切开环形肌;金属钛夹关闭黏膜层切口。结果所有8例患者均成功接受POEM手术,无1例因为护理配合出现与POEM相关的严重并发症。8例患者吞咽困难等症状得到明显改善,均顺利出院。结论经口内镜下肌切开术治疗贲门失弛缓症短期疗效肯定。护理配合中的快、稳、准可有效地减少手术的并发症,提高手术治疗的安全性。     

Bladder pressure monitoring and CO<Subscript>2</Subscript> gas-related adverse events during per-oral endoscopic myotomy

Per-oral endoscopic myotomy (POEM) is a minimally invasive treatment for esophageal achalasia. However, POEM has the potential risk of inducing carbon dioxide (CO₂) gas-related adverse events, such as pneumoperitoneum, pneumomediastinum, and pneumothorax. The aim of this study was to evaluate the usability of bladder pressure monitoring as an index of CO₂ gas-related pneumoperitoneum. The monitoring of bladder pressure and lung compliance and the incidence of iatrogenic pneumoperitoneum were retrospectively studied in 20 patients who underwent POEM between June 2013 and March 2015. The bladder pressure was measured using a Foley catheter. Abdominal distention was found in nine patients. The bladder pressure was significantly higher in the nine patients with the distention findings compared with patients without distention [7 (6–9) mmHg vs. 1 (0–2) mmHg; P?<?0.05]; however, the decrease in dynamic lung compliance was not significantly different compared with patients without distention [??7 (??9.3 to ??5.1) vs. ??5 (??10.2 to ??1.3) ml/cmH₂O; P?=?0.62]. Based on postoperative changes on CT scans; the following were the observations: pneumomediastinum (55%), minor pneumothorax (5%), pleural effusion (45%), atelectasis (15%), pneumoperitoneum (85%), and subcutaneous emphysema (15%). No significant clinical status was found among the patients postoperatively. Bladder pressure monitoring might be useful for detecting pneumoperitoneum during POEM.     

Chemically assisted peroral endoscopic myotomy with submucosal mesna injection in a porcine model

Background: Peroral endoscopic myotomy (POEM) is a less invasive alternative to standard surgery for the treatment of achalasia. Previous studies have demonstrated that submucosal injections of mesna soften tissues and facilitate endoscopic submucosal dissection. Material and methods: We studied the technical feasibility of a chemically assisted POEM procedure with mesna injection (CA-POEM) in ten pigs compared with POEM with saline injection in five pigs. We also compared two dissection techniques in CA-POEM, diathermy needle knife dissection (n = 5) and balloon mechanical dissection (n = 5). A 10 cm esophageal submucosal tunnel was created with a needle knife or with balloon mechanical dissection following mesna or saline submucosal injection. Approximately 5 cm of inner circular muscle was then dissected within the tunnel. The tunnel was closed with endoclip application at the mucosal endoscopic entry point. Pigs were sacrificed one week post procedure. Results: All procedures were successful and all pigs survived for one week. Submucosal tunneling time was significantly shorter in the mesna group (363.8 sec for needle knife dissection and 294.2 sec for balloon dissection) than in the saline group (640 sec), regardless of the dissection method (p < 0.05). Conclusions: Our study demonstrated the technical feasibility of CA-POEM.