经口内镜下肌切开术治疗贲门失弛缓症的护理

目的探讨经口内镜下肌切开术(POEM)治疗贲门失弛缓症(AC)的临床方法和护理。方法研究确诊为AC并接受POEM治疗的6例患者的临床资料。POEM主要步骤:食管黏膜层切开;分离黏膜下层,建立黏膜下"隧道";胃镜直视下切开环形肌;金属夹关闭黏膜层切口。护士做好术前、术中配合和术后护理工作。结果 6例患者均成功完成POEM手术,手术时间60~128 min,平均76.5 min,黏膜下隧道长度9~12 cm,平均10.3 cm,环形肌切开长度7~10 cm,平均8.2 cm,1例出现皮下气肿,1例左侧气胸。术后随访l~10个月,6例吞咽困难均明显得到解除。结论 POEM治疗AC短期疗效肯定,可以迅速缓解患者吞咽困难,但其长期疗效及远期并发症仍有待随访观察。要求术者有较高的内镜操作水平,良好的术中医护配合及严密的病情观察和护理是手术成功的关键。

Nursing of achalasia of cardia with peroral endoscopic myotomy

Objective To discuss the clinical methods and nursing of peroral endoscopic myotomy(POEM) in treating achalasia of cardia(AC).Methods The clinical data of 6 POEM patients diagnosed with AC were retrospectively reviewed.The main procedures of POEM were composed of esophageal mucosal incision,submucosal tunneling by endoscopic submucosal dissection(ESD),endoscopic myotomy of the circular muscle and closure of mucosal entry by hemostatic clips.The nursing cooperation and care were performed during the preoperative,intraoperative and postoperative periods.Results All the 6 patients underwent POEM successfully.The operation duration ranged from 60 to 128 mins with an average length of 76.5 mins.The length of submucosal tunnel was 9 to 12cm with an average length of 10.3 cm.The length of endoscopic myotomy of inner circular muscle was 7 to 10 cm with an average length of 8.2 cm.One patient had pneumohypoderma,and another patient had left pneumothorax.Patients were followed up for 1 to 10 months.Dysphagia was relieved significantly during the follow-up period in all six patients.Conclusion POEM is very effective to relieve dysphagia in a short term.However,further observation is needed to evaluate long-term efficacy and complications.The high-level endoscopy operation skills are expected from the doctor.The key to a successful surgery includes the close intraoperative cooperation among medical staff,careful clinical observation of the progression and dedicated care.