海博刀与三角刀在经口内镜下肌切开术中疗效的回顾性队列研究

Clinical effects of Hybrid knife versus triangular tip on peroral endoscopic myotomy for patients with achalasia： a retrospective cohort study

目的比较海博刀与三角刀在经口内镜下肌切开术（POEM）中的临床疗效。方法采用回顾性队列研究设计，纳入2012年6月至2014年7月因贲门失弛缓症在南方医科大学南方医院接受POEM治疗的患者，术中使用海博刀者为海博刀组，使用注射针和三角刀者为三角刀组，比较2组手术相关参数、术后症状缓解及并发症发生率。结果共纳入57例患者，其中海博刀组25例，三角刀组32例。2组患者基线特征比较差异无统计学意义（P〉0.05）。海博刀组平均手术时间短于三角刀组[（55.3±17.7）min比（69.5±9.4）min，P=0.038）]；术中平均器械交换次数少于三角刀组[（4.5±1.5）次比（10.7±1.7）次，P=0.000]。所有患者无严重不良事件发生。在1年的随访中，海博刀组治疗成功率为92.0%（23/25），三角刀组为96.9%（31/32），差异无统计学意义（P=0.576）。结论海博刀能显著缩短POEM手术时间，并且获得与三角刀相似的治疗成功率。

ObjectiveTo compare the clinical efficacy and safety of Hybrid knife versus triangular tip during peroral endoscopic myotomy（POEM） for patients with achalasia of cardia.MethodsData of patients with achalasia of cardia who received POEM in Nanfang Hospital, Southern Medical University from June 2012 to July 2014 were collected and divided into the Hybrid knife group （using Hybrid knife） and triangular tip group （using injection needle and triangular tip）. Procedure-related parameters, symptom relief, and adverse events were compared between the two groups.ResultsA total of 57 patients were selected, including 25 patients in the Hybrid knife group and 32 in the triangular tip group. There were no significant differences on baseline characteristics between the two groups （P〉0.05）. The mean procedure time was shorter in the Hybrid knife group than that in the triangular tip group （55.3±17.7 min VS 69.5±9.4 min, P=0.038）. The mean frequency of devices exchange was less in the Hybrid knife group than that in the triangular tip group （4.5±1.5 VS 10.7±1.7, P=0.000）. No serious complications occurred during operation and periodical follow-up in both groups. At one-year follow-up, the treatment success rate was 92.0%（23/25） in the Hybrid knife group and 96.9% （31/32） in the triangular tip group （P=0.576）.ConclusionUsing Hybrid knife in POEM can shorten procedural time and achieve similar treatment success rate compared to triangular tip.