贲门失弛缓症应用横开口法、纵开口法经口内镜下肌切开术治疗疗效比较研究

A comparative study on the therapeutic effect of cardiac achalasia treated by transverse opening method and longitudinal opening method

目的:探讨纵开口法与横开口法在贲门失弛缓症经口内镜下肌切开术治疗中的疗效差异。方法:选取贲门失弛缓症患者68例,采用随机数字表法将其分为观察A组和观察B组。两组均采用经口内镜下肌切开术(POEM)进行治疗,其中观察B组采用纵开口法、观察A组采用横开口法,对两组手术治疗效果、手术时间等指标进行观察分析。结果:经POEM手术治疗后患者相关指标均得到显著改善,其食管下端括约肌4s完全松弛压、静息压明显下降,Eckardt评分明显降低,同术前相比具有统计学差异(P<0.05),但组间对比并无统计学差异(P>0.05);观察A组手术总耗时、隧道建立时间、环形肌切开时间均明显短于观察B组,差异具有统计学意义(P<0.05);观察A组术后气体相关并发症发生率明显低于观察B组,差异具有统计学意义(P<0.05)。结论:纵开口法、横开口法经口内镜下肌切开术均是有效的贲门失弛缓症手术方式,可有效促进患者临床症状的好转,但其中横开口法较纵开口法可有效缩短手术时间,便于内镜活动,有利于降低气体相关并发症的发生风险,对于促进患者术后恢复,提高其生活质量有积极意义。

Objective:To explore the difference of the effect of longitudinal opening method and transverse opening method in the treatment of achalasia with oral achalasia.Methods:68 patients with achalasia were divided into observation group A and group B by random number table.Both groups were treated with endoscopic The patients were treated with longitudinal opening method,and the patients in group B were treated with transverse opening method.The operation and operation time of the two groups were observed and analyzed.Results:After treatment with POEM,the related indexes of patients were significantly improved,The lower esophageal sphincter 4s complete relaxation pressure,resting pressure decreased significantly,Eckardt score was significantly reduced(P<0.05),but there was no significant difference between the two groups(P>0.05).The time of total operation,the establishment time of tunnel and the time of excision of ring muscle were significantly shorter than those of group B,The difference was significant(P<0.05).The incidence of postoperative gas-related complications was significantly lower in group A than in group B(P<0.05).Conclusion:Longitudinal opening method,transverse opening endoscopic endoscopic muscle incision are effective achalasia surgery,which can effectively promote the improvement of clinical symptoms of patients,but the horizontal opening method can be more effective than the opening method to shorten the operation time,Easy to endoscopic activities,is conducive to reducing the risk of gas-related complications for the promotion of patients with postoperative recovery,improve their quality of life has a very positive significance.