本文選題：內(nèi)鏡下經(jīng)口肌切開術(shù)　切入點(diǎn)：賁門失弛緩癥　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過(guò)比較POEM(Peroral endoscopic myotomy,內(nèi)鏡下經(jīng)口肌切開術(shù))手術(shù)對(duì)不同壓力分型AC(Achalasia,賁門失弛緩癥)患者的食管功能參數(shù)和臨床癥狀的影響,評(píng)價(jià)POEM術(shù)式對(duì)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(biāo)準(zhǔn)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(shù)前曾接受治療干預(yù)者9例,未接受過(guò)治療者11例,術(shù)前食道測(cè)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(shù),應(yīng)用Eckardt(賁門失弛緩臨床癥狀)評(píng)分法比較兩組患者術(shù)前術(shù)后癥狀改善情況;通過(guò)HRM(Highresolution manometry,高分辨率食管測(cè)壓)檢測(cè),比較兩組患者術(shù)前術(shù)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(zhǎng)度)變化,獲得并比對(duì)不同類型患者行POEM術(shù)式術(shù)后療效及并發(fā)癥發(fā)生情況。統(tǒng)計(jì)學(xué)分析使用SPSS19.0。結(jié)果:根據(jù)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(shù)為(10.00±2.10)天,平均手術(shù)時(shí)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(shù)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(kuò)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(shù)為(11.57±2.77)天,平均手術(shù)時(shí)間為(67.86±20.11)分鐘。I型、II型各基礎(chǔ)資料(性別、年齡、病程、既往是否接受治療)之間均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。Ⅰ型Ⅱ型賁門失弛緩癥患者對(duì)比,術(shù)中并發(fā)癥(出血、黏膜層損傷、皮下氣腫、氣腹)、術(shù)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(yīng)(上腹部疼痛、腹脹、胸悶氣短),均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。將兩種分型AC患者行POEM手術(shù),手術(shù)前后各參數(shù)進(jìn)行對(duì)比,兩種分型Eckardt評(píng)分比較,Ⅰ型術(shù)后較術(shù)前下降(4.83±0.75)分,Ⅱ型術(shù)后較術(shù)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(shù)比較,Ⅰ型術(shù)后較術(shù)前下降(10.62± 1.24),Ⅱ型術(shù)后較術(shù)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(xiàng)差值比較均有統(tǒng)計(jì)學(xué)意義,P＜0.05。而兩種分型LESL參數(shù)比較P=0.35,變化無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:1.性別、年齡、病程、既往是否接受治療對(duì)不同分型AC患者POEM手術(shù)成功率無(wú)明顯影響。2.POEM術(shù)式治療AC安全系數(shù)高,兩種分型患者術(shù)中、術(shù)后并發(fā)癥與不良反應(yīng)均無(wú)明顯差異。3.POEM術(shù)式對(duì)Ⅰ型和Ⅱ型AC患者均具有顯著療效,但是Ⅱ型患者術(shù)后Eckardt評(píng)分及HRM檢測(cè)中LESP參數(shù)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(hào)：1570630