经口内镜幽门括约肌切开术治疗胃下垂14例的疗效分析

The effect analysis of gastric peroral endoscopic myotomy in the treatment of 14 cases of gastroptosis

目的分析经口内镜幽门括约肌切开术(G-POEM)治疗胃下垂的有效性和安全性。方法回顾性收集2016年8月1日至2020年8月1日于东南大学附属中大医院行G-POEM的14例胃下垂患者的基线资料,包括年龄、体重、住院时间、修正后胃轻瘫主要症状指数评分(mGCSI)等。规律随访并记录相关资料进行对比分析,主要观察指标为体重和mGCSI。统计学方法采用Friedman秩和检验与Bonferroni校正检验。结果14例胃下垂患者的年龄为50.0岁(24.5岁),所有患者均顺利完成手术,均未发生严重手术并发症,住院时间为10.5 d(5.0 d),术后随访时间均>12个月。14例患者的术前、术后1周、术后1个月、术后3个月、术后6个月、术后12个月的mGCSI[1.94分(1.19分)、0.78分(0.47分)、0.36分(0.19分)、0.17分(0.45分)、0.13分(0.57分)、0.29分(0.50分)]和体重[43.5 kg(5.8 kg)、43.5 kg(5.8 kg)、42.5 kg(7.1 kg)、43.5 kg(6.9 kg)、45.0 kg(8.0 kg)、45.5 kg(7.5 kg)]比较,差异均有统计学意义(Z=42.78、34.28,均P<0.001);Bonferroni校正后两两比较结果显示,14例患者的术前mGCSI与术后1、3、6、12个月的mGCSI分别比较,差异均有统计学意义(Z=4.09、5.05、5.00、4.14,P=0.001、<0.001、<0.001、=0.001);14例患者术后12个月的体重与术前、术后1周、术后1个月的体重分别比较,差异均有统计学意义(均Z=-3.64,均P=0.004)。结论G-POEM对胃下垂患者有良好疗效,有望成为治疗胃下垂的新方式。

Objective Analyze the efficacy and safety of gastric peroral endoscopic myotomy(G-POEM)in the treatment of gastroptosis.Methods From August 1,2016 to August 1,2020,at Zhongda Hospital,Southeast University,the baseline data of 14 patients with gastroptosis who underwent G-POEM were retrospectively collected,including age,weight,length of hospital stay,and modified gastroparesis cardinal symptom index(mGCSI).Regular follow-ups were made,and relevant data were recorded for comparative analysis.The main observation indicators were body weight and mGCSI.Friedman rank sum test and Bonferroni correction test were used for statistical analysis.Results The age of 14 patients with gastroptosis was 50.0 years old(24.5 years old),the operations were successfully completed in all patients without any serious surgical complications,the time of hospital stay was 10.5 d(5.0 d),and all the postoperative follow-up time was>12 months.There were statistically significant differences in mGCSI and body weight between before operation and at 1st week,1st month,3rd month,6th month,and 12th month after operation(1.94(1.19),0.78(0.47),0.36(0.19),0.17(0.45),0.13(0.57)and 0.29(0.50),43.5 kg(5.8 kg),43.5 kg(5.8 kg),42.5 kg(7.1 kg),43.5 kg(6.9 kg),45.0 kg(8.0 kg)and 45.5 kg(7.5 kg);Z=42.78 and 34.28,both P<0.001).After Bonferroni correction in the pairwise comparison,there were statistically significant differences in the mGCSI of the 14 patients between before operation and at 1st month,3rd month,6th month,and 12th month after operation(Z=4.09,5.05,5.00 and 4.14,P=0.001,<0.001,<0.001 and=0.001).The weight of 14 patients at 12th month after operation were compared with the weight before operation,1st week after operation,and 1st month after operation,and the differences were statistically significant(all Z=-3.64,all P=0.004).Conclusion G-POEM has a good therapeutic effect on patients with gastroptosis and is expected to become a new treatment for gastroptosis.