应用短刀头强力电凝行经口内镜食管下括约肌切开术治疗贲门失弛缓症的效果

Application of short knife head strong electrocoagulation in peroral endoscopic myotomy for achalasia

摘要:

目的 分析应用回缩Dual刀头强力电凝行经口内镜食管下括约肌切开术（POEM）治疗贲门失弛缓症（AC）的安全性及有效性。方法 分析2016年1月－2019年3月广州医科大学附属第一医院29例AC患者的临床资料，患者均接受POEM治疗，随访满24个月。记录手术操作时间、术中及术后并发症发生率和Eckardt评分。结果 平均手术时间为（37.28±10.56）min。术中明显出血后电凝止血5例（17.2%），术中捻发感9例（31.0%），所有患者术中和术后均无严重并发症发生。随访24个月，28例患者术后Eckardt评分为（1.20±0.41）分，较术前的（7.50±1.83）分明显降低（P < 0.05）；另1例患者行第1次POEM术后12个月Eckardt评分为4分，行第2次POEM术后随访24个月Eckardt评分为1分。结论 对AC患者行POEM，术中应用短刀头强力电凝，手术时间较短，可降低术中精细操控难度，具有较高的安全性和有效性，利于POEM术的开展。

Abstract:

Objective To analyze the safety and effectiveness of retractive Dual-knife head strong electrocoagulation in peroral endoscopic myotomy (POEM) for treatment of achalasia (AC).Methods 29 patients with AC receiving POEM treatment from January 2016 to March 2019 and followed up for 24 months were collected. The operation time, intraoperative, postoperative complication rate, and Eckardt score were recorded.Results The mean operation time was (37.28 ± 10.56) min. There were 5 cases (17.2%) with electrocoagulation hemostasis after obvious intraoperative bleeding, and 9 cases (31.0%) with twisting sensation during operation, no serious intraoperative and postoperative complications occurred in all patients. Following up for 24 months, the Eckardt score of 28 patients was significantly decreased after surgery [(1.20 ± 0.41)] compared with that before surgery [(7.50 ± 1.83)] (P < 0.05); One patient received 4 Eckardt scores 12 months after the first POEM and 1 Eckardt score 24 months after the second POEM.Conclusion The short knife head powerful electrocoagulation method is used in POEM for AC patients, the operation time is short, can reduce the difficulty of fine manipulation, and has higher safety and effectiveness, which is conducive to the development of POEM.