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POEM手术与腹腔镜Heller手术治疗贲门失驰缓症的有效性及安全性观察

Efficacy and safety of laparoscopic Heller myotomy and peroral endoscopic myotomy in patients with achalasia of the cardia
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摘要 目的探讨经口内镜下肌切开术(POEM手术)与腹腔镜Helle手术治疗贲门失驰缓症的有效性及安全性。方法选取本院2015年1月至2017年1月收治的109例贲门失弛缓症患者进行研究,按随机数字表法将其分为研究组与对照组,对照组患者采用POEM手术治疗,研究组患者采用腹腔镜Heller手术治疗,治疗后比较两组患者手术时间、住院时间、术中出血量、住院费用、贲门失驰缓症评分量表(Eckardt评分)、食管最大宽度、复发及并发症发生情况。结果研究组患者手术时间[(54.17±26.35)min比(125.63±31.76)min]与住院时间[(5.76±1.08)d比(7.64±1.47)d]均较对照组短,术中出血量[(11.28±3.12)ml比(73.61±38.29)ml]与住院费用[(1.68±0.71)万元比)2.19±0.54)万元]较对照组低,差异均有统计学意义(均P〈0.05)。手术前后两组患者Eckardt评分及食管最大宽度比较差异均无统计学意义(均P〉0.05)。术后两组患Eckardt评分及食管最大宽度均下降,与术前比较差异有统计学意义(P〈0.05)。研究组发生5例(9.09%)并发症,对照组发生3例(5.56%)并发症.两组比较差异无统计学意义(χ^2=0.501,P〉0.05)。随访中发现,研究组3例(5.56%)患者复发,对照组未见复发,两组比较差异无统计学意义(χ^2=1.334,P〉0.05)。结论POEM手术与腹腔镜Heller手术均可有效改善贲门失弛缓症患者临床症状,POEM手术在经济效益和减少创伤方面存在一定优势。 Objective To investigate the efficacy and safety of laparoscopic Heller myotomy and peroral endoscopic myotomy (POEM) in patients with achalasia of the cardia. Methods 109 cases of patients with achalasia of the cardia in our hospital from January 2015 to January 2017 were chosen as experimental subjects, and were divided into control group and research group with the random number table. The control group was treated with POEM, and the research group was treated with laparoscopic Heller myotomy. After the treatment, operation time, time of hospitalization, intraoperative bleeding, hospitalization expenses, Eckardt score, maximum width of the esophagus, recurrence, and complications were compared between the two groups. Results The operation time and time of hospitalization of the research group were shorter than those of the control group [(54.17±26.35)min vs.(125.63±31.76) min, (5.76±1.08)d vs.(7.64±1.47)d], intraoperative bleeding and hospitalization expenses were less than those of the control group [(11.28±3.12)ml vs.(73.61±38.29)ml, (1.68±0.71) ten thousand yuan vs.(2.19±0.54) ten thousand yuan], with statistically significant differences (P〈0.05). There were no statistically significant differences in the Eckardt score and the maximum width of the esophagus between the two groups before and after the treatment (P〉0.05). After the treatment, the Eckardt score and the maximum width of the esophagus were decreased in both two groups, with statistically significant differences compared with those before the treatment (P〈0.05). There were 5 cases (9.09%) of complications in the research group and 3 cases (5.56%) in the control group, without statistically significant difference in the incidence of complications (χ^2=0.501, P〉0.05). During the follow-up, there were 3 cases (5.56%) of recurrence in the research group, and no recurrence in the control group, without statistically significant difference in the recurrence rate (χ^2=1.334, P〉0.05). Conclusion Laparoscopic Heller myotomy and peroral esophageal myotomy both can effectively improve the clinical symptoms of patients with achalasia of the cardia, peroral esophageal myotomy has some advantages in economic benefits and reduction of trauma.
作者 张长存 张会平 Zhang Changcun;Zhang Huiping(Department of Thoracic Surgery, People's Hospital of Xuecheng, Zaozhuang 277000, Chin;Department of Rehabilitation, People's Hospital of Xuecheng, Zaozhuang 277000, China)
出处 《国际医药卫生导报》 2018年第11期1657-1661,共5页 International Medicine and Health Guidance News
关键词 贲门失弛缓症 腹腔镜Heller手术 经口内镜下肌切开术 Achalasia of the cardia Laparoscopic Heller myotomy Peroral esophageal myotomy
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