胃三维容积超声造影与上消化道碘水造影在G-POEM手术疗效评估中的价值分析

目的 探讨胃三维容积超声造影与上消化道碘水造影在G-POEM手术疗效评估中的价值，从而为临床选择更合适的影像学检查方法。方法 经东南大学附属中大医院消化科医生确诊胃轻瘫且需要进行G-POEM手术的患者共93例，根据胃排空检查方法的不同分为A组（超声胃三维容积检查）和B组（X线碘水造影检查），其中A组48例、B组共46例，A组口服超声造影剂后在5min、15min、30min、60min及90min时间点时进行超声测量，B组在口服碘水造影剂后在上述相同时间点进行上腹部平片，上述方法在G-POEM手术前、后各测量一次，分别得到三维超声造影方法及碘水造影方法估测的G-POEM手术前、后的胃容积，从而各自评估G-POEM手术的有效后的胃排空改善情况，并进行比较分析。结果1、完成A组胃三维超声造影方法检查的成功率为97.9%，完成B组上消化道碘水造影检查的成功率为97.8%，两组检查成功率没有统计学差异（P＞0.05）；2、A组检查中胃排空时间明显减少的有效例数为31例，胃排空时间由术前的90（90，90）min减少至术后的30（15，60）min（P＜0.05），B组检查中胃排空时间明显减少的有效例数为31例，胃排空时间由术前的90（90，90）min减少至术后的30（15，60）min（P＜0.05）。3、A组术前及术后排胃空时间均为90min的16例患者中，90min时间点测量时胃排空率较术前明显改善的有效例数为8例，由术前的61.6%（55.9%，73.6%）增加至术后的78.1%（74.1%，91.6%）（P＜0.05），胃排空无明显改善的例数为8例（P＞0.05）， B组术前及术后排空时间均为90min的14例患者中，90min时间点测量时胃排空率较术前明显改善的有效例数为5例，由术前的25.0%（25.0%，50.0%）增加至术后的75.0%（70.0%，90.0%） (P＜0.05)，胃排空无明显改善的例数为9例（P＞0.05）。4、A组47例超声造影患者中有39例患者的胃排空情况得到了改善（P＜0.05），其中31例患者的胃排空情况较术前显著改善，8例患者的胃排空情况得到了改善，另8例患者的胃排空情况没有得到改善（P＞0.05）；B组45例碘水造影患者中有36例患者的胃排空情况得到了改善（P＜0.05），其中31例患者的胃排空情况有明显的改善，5例患者的胃排空情况得到了改善，另9例患者的胃排空情况没有得到改善（P＞0.05）。A、B两组影像学检查评估结果的G-POEM手术后胃排空改善有效率分别为83.0%、80.0%，两组影像学检查结果没有明显差异(P＞0.05)。结论 胃三维超声容积测定方法及上消化道碘水造影方法均可以对G-POEM前后的胃排空情况进行评价，两种方法的成功率及评估G-POEM手术后的胃排空改善率符合率没有明显差异性，那么由于超声的独特优势（无辐射/操作简便/患者接受度高等），临床可首选超声胃三维容积检查方法评估G-POEM手术前后的胃排空情况，从而评价G-POEM手术后胃排空功能的改善效果，上消化道碘水造影检查方法作为补充方法，为临床提供客观的影像学数据。

The analysis of efficacy rate of contrast-enhanced volume three-dimensional ultrasonography and iodinated water contrast-enhanced fluoroscopy to determine the gastric emptying time after G-POEM in gastroparesis patients

1.Objective To explore the value of Gastric three-dimensional volume ultrasonography and iodinated water contrast agent fluoroscopy in G-POEM, so as to choose more suitable imaging examination method clinically.2.Methods A total of 93 patients with gastroparesis were divided into two groups according to the different methods of gastric emptying who were diagnosed by gastroenterologists in Southeast University affiliated Zhong Da hospital: group A constituted of 48 cases (three-dimensional gastric volume examination) and group B constituted of 46 cases (X-ray iodinated water contrast examination). Group A was examined at 5, 15, 30, 60 and 90 minutes after oral administration of contrast agent. In 3D ultrasound measurement, group B took the upper abdominal X-ray plain film at the same time point after taking the iodinated water contrast agent. The above methods were measured before and after g-poem operation, and the gastric volume before and after g-poem operation was estimated by three-dimensional ultrasound contrast method and iodine water contrast method respectively, from which the efficacy rate of G-POEM operation was evaluated and compared.3.Results 1). The success rate of three-dimensional contrast-enhanced ultrasonography was 97.9% in group A, 97.8% in group B, and there was no significant difference between the two groups (P > 0.05); 2). The gastric emptying time decreased significantly in 31 cases of group A and in group B, significant reduction of gastric emptying time was seen in 31 cases. In both groups, the gastric emptying time decreased from 90 (90, 90) minutes before operation to 30 (15, 60) minutes after operation (P < 0.05). 3). In group A, among 16 patients whose gastric emptying time was 90 minutes before and after operation, 8 cases had significant improvement in the gastric emptying volume rate after operation, which increased from 61.6% (55.9%, 73.6%) before operation to 78.1% (74.1%, 91.6%) after operation (P < 0.05), and in 8 cases no significant improvement was observed (P > 0.05). Similarly, in group B, among 14 patients whose gastric emptying time was 90 minutes before and after operation, 5 cases had significant improvement in the gastric emptying volume rate after operation, was increased from 25.0% (25.0%, 50.0%) before operation to 75.0% (70.0%, 90.0%) after operation (P < 0.05), and in 9 cases no significant improvement was observed (P > 0.05). 4).The gastric emptying of 39 of the 47 patients with contrast-enhanced ultrasound in group A was improved (P <0.05). The gastric emptying of 31 patients was significantly improved compared with that before surgery, and the gastric emptying of 8 patients was improved. The gastric emptying of the other 8 patients did not improve (P> 0.05); the gastric emptying of 36 of the 45 patients with iodine angiography in group B was improved (P <0.05), of which 31 The gastric emptying of one patient was significantly improved compared with that before surgery. The gastric emptying of 5 patients was improved, and the gastric emptying of the other 9 patients was not improved (P> 0.05). The improvement rates of gastric emptying after G-POEM evaluation by imaging examinations in groups A and B were 83.0% and 80.0%, respectively. There was no significant difference observed between the two groups (P > 0.05).4.Conclusion Both the three-dimensional ultrasonography and iodinated water contrast agent fluoroscopy can evaluate the effect of g-poem. There is no significant difference between the two methods in the success rate and the coincidence rate. Because of the unique advantages of ultrasonography (no radiation / simple operation / high patient acceptance), the three-dimensional ultrasonography can be the first choice to evaluate the effect of operation. As a supplementary method, iodinated water contrast agent fluoroscopy can provide objective imaging data for clinic.