经口内镜肌切开术治疗贲门失弛缓症并发症及其防治探讨

目的探讨经口内镜下肌切开术治疗贲门失弛缓症并发症及其防治情况，为该手术的进一步开展提供经验指导。方法收集2010年8月至2011年7月采用经口内镜下肌切开术治疗贲门失弛缓症119例患者资料，总结术中、术后以及随访过程中并发症的发生及治疗情况。结果术中并发症包括出血16．0％（19／119），黏膜层破损7．6％（9／119），皮下和纵隔气肿22．7％（27／119），气胸2．5％（3／119）。手术当晚并发症包括疼痛36．1％（43／119）、气胸5．9％（7／119）。术后并发症包括：气胸19．3％（23／119）、迟发性出血0．8％（1／119）、胸腔积液48．7％（58／119）、肺部少量炎症或节段性肺不张49．6％（59／119）、纵隔及皮下气肿63．9％（76／119）、隔下气体或气腹39．5％（47／119）。随访过程中并发症：黏膜层狭窄致进食困难1例和隧道开121裂口，食物蓄积1例。全组无一例与手术相关死亡病例，所有并发症经对症、保守治疗痊愈，无一例追加外科手术病例。结论POEM术的主要并发症是纵隔、皮下气肿，气胸，气腹，以及出血等，经对症保守治疗均可及时有效处理。

Peri-operative managements of complications of peroral endoscopic myotomy for esophageal achalasia

Objective To investigate the managements of complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA).Methods Data of 119 EA patients who underwent POEM from October 2010 to July 2011 were collected.Complications during and after POEM and during follow-up were analyzed.Results Complications during operation included bleeding in 19 patients ( 16.0％ ),mucosa rupture in 9 (7.6％),mediastinal and subcutaneous emphysema in 27 (22.7％ ) and pneumothorax in 3 (2.5％ ).Complications occurred at the night of procedure included pain in 43 (36.1％ ) patients and pneumothorax in 7 ( 5.9％ ).Postoperative complications included asymptomatic pneumothorax in 23 patients (19.3％),delayed hemorrhage in 1 (0.8％),pleural effusion in 58 (48.7％ ),minor pulmonary inflammation or segmental atelectasis in 59 (49.6％),emphysema of mediasti-na and subcutaneous tissue in 76 (63.9％ ),and gas under diaphragm or aeroperitoneum in 47 (39.5％ ).Complications during follow-up included one case of dysphagia caused by stricture of mucosa and one case of dehiscence at the tunnel entry with food retention.No POEM-correlated death occurred.All the complications were cured by conservative treatments.No additional surgery was needed.Conclusion Main complications as emphysema of mediastina and subcutaneous tissue,pneumothorax,aeroperitoneum and bleeding during and after POEM can be treated timely and effectively with conservative treatment.