本文選題：內鏡下經口肌切開術　切入點：賁門失弛緩癥　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:通過比較POEM(Peroral endoscopic myotomy,內鏡下經口肌切開術)手術對不同壓力分型AC(Achalasia,賁門失弛緩癥)患者的食管功能參數和臨床癥狀的影響,評價POEM術式對于不同類型AC患者治療的療效。方法:2014年10月至2016年10月就診于我院消化科,并符合納入標準者共20例,其中男10例,女10例,平均年齡為(47.25±13.40)歲,病程為(4.00±2.53)年,術前曾接受治療干預者9例,未接受過治療者11例,術前食道測壓且參照芝加哥分類2014年V3.0示I型AC患者6例,II型AC患者14例�；颊哂谌朐汉缶蠵OEM手術,應用Eckardt(賁門失弛緩臨床癥狀)評分法比較兩組患者術前術后癥狀改善情況;通過HRM(Highresolution manometry,高分辨率食管測壓)檢測,比較兩組患者術前術后LESP(Lower esophageal sphincter pressure,食管下括約肌壓力)、LESL(Lower esophageal sphincter length,食管下括約肌長度)變化,獲得并比對不同類型患者行POEM術式術后療效及并發(fā)癥發(fā)生情況。統(tǒng)計學分析使用SPSS19.0。結果:根據芝加哥分型示I型賁門失弛緩癥者6例,男性4人,女性2人,既往接受口服藥物治療1例,平均年齡為(40.17± 13.17)歲,平均病程為(3.17± 1.94)年,平均住院天數為(10.00±2.10)天,平均手術時間為(60.67±27.32)分鐘。II型賁門失弛緩癥者14例,男性6人,女性8人,術前行口服藥物治療患者6例,行肉毒桿菌素治療患者1例,行球囊擴張患者2例,平均年齡為(50.29±12.75)歲,平均病程為(4.36±2.74)年,平均住院天數為(11.57±2.77)天,平均手術時間為(67.86±20.11)分鐘。I型、II型各基礎資料(性別、年齡、病程、既往是否接受治療)之間均無統(tǒng)計學差異(P0.05)。Ⅰ型Ⅱ型賁門失弛緩癥患者對比,術中并發(fā)癥(出血、黏膜層損傷、皮下氣腫、氣腹)、術后并發(fā)癥(少量胸腔積液、感染發(fā)熱、氣胸、氣腹、縱隔游離氣體)與不良反應(上腹部疼痛、腹脹、胸悶氣短),均無統(tǒng)計學差異(P0.05)。將兩種分型AC患者行POEM手術,手術前后各參數進行對比,兩種分型Eckardt評分比較,Ⅰ型術后較術前下降(4.83±0.75)分,Ⅱ型術后較術前下降(6.14±0.95)分,Ⅱ型癥狀改善程度較Ⅰ型明顯,P=0.01;兩種分型患者LESP參數比較,Ⅰ型術后較術前下降(10.62± 1.24),Ⅱ型術后較術前下降(12.94± 1.99),Ⅱ型壓力降低程度較Ⅰ型更明顯,P=0.02,兩項差值比較均有統(tǒng)計學意義,P＜0.05。而兩種分型LESL參數比較P=0.35,變化無統(tǒng)計學意義。結論:1.性別、年齡、病程、既往是否接受治療對不同分型AC患者POEM手術成功率無明顯影響。2.POEM術式治療AC安全系數高,兩種分型患者術中、術后并發(fā)癥與不良反應均無明顯差異。3.POEM術式對Ⅰ型和Ⅱ型AC患者均具有顯著療效,但是Ⅱ型患者術后Eckardt評分及HRM檢測中LESP參數緩解程度更明顯。
[Abstract]:Objective: to compare the effects of POEM(Peroral endoscopic myotomy (POEM(Peroral endoscopic myotomy) on esophageal function parameters and clinical symptoms in patients with Achalasia (achalasia) under different pressure types. Methods: from October 2014 to October 2016, 20 patients (10 males and 10 females) were admitted to our hospital from October 2014 to October 2016. The mean age was 47.25 鹵13.40 years and the course of disease was 4.00 鹵2.53 years. There were 9 patients who had received treatment intervention before operation, 11 patients who had not received treatment before operation, 14 patients with type I AC, 6 patients with type I AC according to Chicago classification V3.0 on 2014. All patients underwent POEM operation after admission. Eckardt score was used to compare the improvement of symptoms before and after operation between the two groups, and HRM(Highresolution manometry (high resolution esophageal manometry) was used. The changes of LESP(Lower esophageal sphincter pressure, lower esophageal sphincter pressure and lower esophageal sphincter length were compared between the two groups before and after operation. SPSS 19.00.Results: according to Chicago classification, 6 patients (4 males and 2 females) had achalasia of cardia type I, 4 males and 2 females. One patient received oral drug therapy with an average age of 40.17 鹵13.17 years, an average course of disease of 3.17 鹵1.94 years, an average hospital stay of 10.00 鹵2.10 days, and an average operative time of 60.67 鹵27.32 minutes for type II achalasia, 6 males and 8 females. Before operation, 6 patients were treated with oral drug therapy, 1 with Botox and 2 with balloon dilatation. The average age was 50.29 鹵12.75 years, the average course of disease was 4.36 鹵2.74 years, and the average hospital stay was 11.57 鹵2.77 days. The average operative time was 67.86 鹵20.11 minutes. There was no significant difference in the basic data (sex, age, course of disease, and whether or not received treatment) between the patients with type I type I and type 鈪，

本文編號：1570630