摘要
目的观察经口内镜下肌肉切开术(POEM)、球囊扩张(PD)治疗贲门失弛缓症临床效果。方法选择2015年3月—2016年3月哈尔滨医科大学附属第二医院消化内科收治贲门失弛缓症患者90例作为研究对象,按照手术方式不同分为POEM组和PD组各45例比较2组患行者手术一般情况,治疗前后食管下括约肌压(LESP)、食管下括约肌松弛率(LESRR)、4s整合松弛压(4s-IRP)、症状缓解程度及食管扩张情况,并记录2组患者并发症发生情况。结果POEM组在手术时间、住院时间明显长于PD组(t=9.895、6.130,P=0.000、0.000);治疗3个月后,POEM组LESP、4s-IRP明显低于PD组,LESRR显著高于PD组(t=4.783、4.068、4.742,P=0.000、0.000、0.000);POEM组治疗3个月、1年后Eckardt评分、食管扩张程度均显著低于PD组(t_(3个月)=7.829、5.975、t_(1年)=6.718、7.488,P均=0.000)。2组患者治疗过程中发生穿孔、出血、感染、胸痛、皮下气肿、气胸、食物反流等并发症发生率比较,差异无统计学意义(P>0.05)。结论 PD术操作相对简单,安全性较好,而POEM术较PD术能有效改善贲门失弛缓症食管功能,降低LES压力,减轻吞咽障碍,有利于临床症状缓解。
Objective To compare effect of POEM surgery and pneumatic dilation in the treatment of achalasia of cardia. Methods Ninety cases of patients with achalasia of cardia were selected, which were treated in hospital from March 2015 to March 2016, and they were divided into the POEM group （45 cases） and PD group （45 cases）according to the different surgical methods. Compare the surgical general condition, complication.and changes of the levels of LESP, LESRR,4s IRP, the degree of symptom relief and esophageal dilatation of two groups. Results The operative time, hospital stay of the POEM group were significantly longer than those of the PD group （ t = 9. 895, t = 6.130 ; P = 0. 000, P = 0. 000） ; After the treatment for 3 months, the LESP,4s IRP levels of the POEM group were significantly lower than those of the PD group, and the LESRR levels of the POEM group were significantly higher than those of the PD group （ t = 4. 783, t = 4. 068, t = 4. 742 ; P = 0. 000, P = 0.000, P = 0.000） ; The Eckardt scores, esophageal dilatation of the POEM group were all significantly lower than those of the PD group after treatment for 3 months and one year（ t =7. 829 ,t =5. 975 ,t =6. 718 ,t =7. 488 ; P =0.000 ,P =0.000,P = 0. 000,P = 0. 000 ） ; There were perforation, bleeding, infection, chest pain, subcutaneous emphysema, pneumothorax, food reflux and other complications occurred in both two groups, but there were no statistically significant between the two groups （χ^2 =0.758, =2,381,0.875,0.758,0.505,0.981,2.224; P〉0.05）. Conclusion PD surgery is relatively simple,with good safety. Compared with PD surgery, POEM surgery can effectively improve the esophageal function of patients with achalasia of eardia, reduce the pressure of LES, and reduce the dysphagia,which is conducive to the alleviation of clinical symptoms.
出处
《疑难病杂志》
CAS
2018年第1期55-58,共4页
Chinese Journal of Difficult and Complicated Cases
