本文選題：賁門失弛緩癥 + 經(jīng)口內(nèi)鏡下肌切開術(shù)��； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：探討經(jīng)口內(nèi)鏡下肌切開術(shù)(peroral endoscopic myotomy, POEM)治療賁門失弛癥(achalasia of cardia, AC)的療效和安全性,以及超聲內(nèi)鏡在經(jīng)口內(nèi)鏡下肌切開術(shù)治療賁門失弛緩癥中的應(yīng)用價(jià)值。 方法：采用前瞻性研究方法,納入在廣西醫(yī)科大學(xué)第一附屬醫(yī)院確診為賁門失弛緩癥并接受POEM治療的患者作為研究對象。于術(shù)前行Eckardt's評分,并行超聲內(nèi)鏡檢查,測賁門口、賁門上5cm、責(zé)門上10cm、賁門上15cm處固有肌層厚度。術(shù)中記錄黏膜下隧道長度,固有肌層切開長度、深度,以及并發(fā)癥情況。術(shù)后進(jìn)行隨訪,術(shù)后3個(gè)月、6個(gè)月行Eckardt's評分。 結(jié)果：2013年5月至2013年12月共入選24例診斷為賁門失弛緩癥并接受POEM治療的患者,其平均年齡41.88±10.85歲。責(zé)門口、賁門上5cm、賁門上10cm、賁門上15cm固有肌層厚度分別為：3.01±0.63mm,2.34±0.45mm,1.99±0.34mm,1.49±0.34mm。24名患者術(shù)前Eckardt's評分為6.50±1.35。Spearman秩相關(guān)分析顯示賁門處固有肌層厚度與Eckardt's評分存在正相關(guān)性(r=0.519,P=0.039),與患者病程不存在相關(guān)性(r=0.145,P=0.591)。全組患者均順利完成POEM術(shù),手術(shù)時(shí)間90～240min,黏膜下隧道長度8-12cm,肌切開長度6～10cm,未出現(xiàn)手術(shù)相關(guān)嚴(yán)重并發(fā)癥及死亡。術(shù)后成功電話隨訪24例患者,隨訪時(shí)間3-10個(gè)月,24例患者術(shù)后3個(gè)月Eckardt's評分的為1.04±0.96,較術(shù)前明顯降低(P0.05)。其中11名患者術(shù)后6個(gè)月Eckardt's評分為1.00±0.78,與術(shù)前的6.73±1.56相比下降明顯(P0.05),與術(shù)后3個(gè)月的Eckardt's評分相比較差異無統(tǒng)計(jì)學(xué)差異(P0.05)。 結(jié)論：1.賁門失弛緩癥患者賁門口處固有肌層厚度與患者吞咽困難嚴(yán)重程度正相關(guān),與病程長短無相關(guān)性；2. POEM可以迅速解除賁門失弛緩癥患者吞咽困難癥狀,短期療效肯定,安全性好,但其長期療效及遠(yuǎn)期并發(fā)癥仍有待隨訪和觀察。3.AC患者POEM術(shù)前行超聲內(nèi)鏡檢查對手術(shù)的進(jìn)行有一定的指導(dǎo)意義。
[Abstract]:Objective: to evaluate the efficacy and safety of peroral endoscopic myotomy (poemma) in the treatment of cardia achalasia of cardiac achalasia (ACC), and the value of EUS in the treatment of achalasia.Methods: prospective study was carried out in patients with achalasia diagnosed in the first affiliated Hospital of Guangxi Medical University and treated with POEM.Eckardt's score was performed before operation, and endoscopic ultrasonography was performed. The cardiac orifice, 5 cm above the cardia and 10 cm above the fundus were measured, and the thickness of the lamina propria muscularis propria on the 15cm on the cardia was measured.The length of the submucous tunnel, the length and depth of the incision of the lamina propria, and the complications were recorded during the operation.Follow-up, 3 months, 6 months after the Eckardt's score.Results: from May 2013 to December 2013, 24 patients with achalasia diagnosed and treated with POEM were enrolled, with an average age of 41.88 鹵10.85 years.POEM was performed successfully in all patients. The operative time was 90 ~ 240 min, the length of submucosal tunnel was 8 ~ 12 cm, and the length of muscle incision was 6 ~ 10 cm. There were no severe complications and death associated with the operation.24 patients were followed up by telephone successfully. The Eckardt's score of 24 patients 3 to 10 months after operation was 1.04 鹵0.96, which was significantly lower than that before operation.The Eckardt's score of 11 patients was 1.00 鹵0.78 at 6 months after operation, which was significantly lower than that before operation (6.73 鹵1.56). There was no significant difference in Eckardt's score between 11 patients and 3 months postoperatively (P 0.05).Conclusion 1.The thickness of the lamina propria muscularis in patients with achalasia was positively correlated with the severity of dysphagia, but not with the duration of the disease.POEM can quickly relieve dysphagia in patients with achalasia.However, the long-term curative effect and long-term complications still need to be followed up and observed. 3. EUS endoscopic examination before POEM has certain guiding significance for the operation.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R571

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 游輝;仝巧云;李中艷;袁晉華;楊院平;鄭東萍;龔勇;;經(jīng)超聲內(nèi)鏡引導(dǎo)注射A型肉毒桿菌毒素治療賁門失弛緩癥的療效觀察[J];中國全科醫(yī)學(xué);2010年36期

，

本文編號：1738050