本文選題：賁門失弛緩癥 + 經(jīng)口內(nèi)鏡肌切開術(shù)(POEM)��； 參考：《中南大學(xué)》2014年碩士論文

【摘要】：背景：隨著醫(yī)學(xué)模式向生物-心理-社會醫(yī)學(xué)模式轉(zhuǎn)變,醫(yī)學(xué)治療的對象不僅僅是患者的軀體,還包括疾病及其治療方法造成的患者精力、心理、社會職能及情感等方面的健康問題,因此通過評價健康相關(guān)生存質(zhì)量來全面評價疾病及治療對患者造成的生理、心理和社會生活等方面的影響很重要。賁門失弛緩癥是一種慢性進(jìn)展性疾病,病人通常需要花大量時間、金錢、精力用于疾病治療,嚴(yán)重影響患者的社會心理功能,使患者的健康相關(guān)生存質(zhì)量下降。目前國外有少量關(guān)于球囊擴(kuò)張術(shù)、Heller術(shù)術(shù)后賁門失弛緩癥患者生存質(zhì)量改善的研究,提示這些治療方法能顯著改善患者的生存質(zhì)量。POEM術(shù)是賁門失弛緩癥的一種較新的治療方法,該方法綜合內(nèi)鏡和外科手術(shù)的特點,目前國外罕見POEM術(shù)對賁門失馳緩癥患者生存質(zhì)量影響的研究,尤其國內(nèi)在這方面更是空白。因此,本研究旨在探討POEM術(shù)對賁門失弛緩癥患者療效及生存質(zhì)量的影響。 目的：評價經(jīng)口內(nèi)鏡肌切開術(shù)治療賁門失弛緩癥的療效及生存質(zhì)量。 方法：對35例賁門失馳緩癥患者采用經(jīng)口內(nèi)鏡下肌切開術(shù)治療,應(yīng)用Eckardt癥狀評分、胃鏡及鋇餐檢查等資料對患者臨床療效進(jìn)行評價。同時使用36條目簡明量表(SF-36)進(jìn)行調(diào)查評價患者生存質(zhì)量情況。 結(jié)果：35例患者均成功接受POEM術(shù)治療,手術(shù)成功率為100%,平均操作時間為55分鐘。隧道長度平均14.1cm,肌切開長度平均10.6cm。術(shù)后1月、6月Eckardt癥狀評分均較術(shù)前明顯降低(0.51vs6.83,0.45vs6.83,均P0.05),食管平均直徑較術(shù)前顯著縮小(32.00mm vs47.97mm,28.50mm vs47.97mm,均PO.05)；并發(fā)癥發(fā)生率為14.3%(5/35),其中氣腫發(fā)生率為8.6%(3/35),反流發(fā)生率為1.5%(1／35),頑固性呃逆發(fā)生率為1.5%(1/35)；平均隨訪6.4月,有效率達(dá)100%,隨訪期內(nèi)無1例復(fù)發(fā),復(fù)發(fā)率為0%。本組患者術(shù)前各維度生存質(zhì)量平均得分均較常模降低,其中PF、BP、GH、RE4維度差異有統(tǒng)計學(xué)意義(P0.05)；術(shù)后1月和6月8維度生存質(zhì)量平均得分均顯著高于相應(yīng)維度常模值(P0.05),8維度生存質(zhì)量及生理領(lǐng)域、心理領(lǐng)域平均得分亦均較術(shù)前顯著提高(P0.05),且其得分改善率與術(shù)前相應(yīng)維度基礎(chǔ)得分值均呈負(fù)相關(guān)(P0.05)；術(shù)后1月Eckardt癥狀評分與各維度生存質(zhì)量得分均呈負(fù)相關(guān),而術(shù)后6月Eckardt癥狀評分僅與BP、GH、SF、RE、MH5個維度和生理領(lǐng)域得分、心理領(lǐng)域得分均呈負(fù)相關(guān)(P0.05)；術(shù)后1月和6月隨著年齡增大,生理領(lǐng)域生存質(zhì)量得分越低(P0.05)。 結(jié)論：1. POEM術(shù)是治療賁門失弛緩癥的一種安全有效的方法,短期內(nèi)能顯著改善患者臨床癥狀及食管擴(kuò)張的嚴(yán)重程度。2.賁門失弛緩癥患者POEM術(shù)前生存質(zhì)量低于一般人群,術(shù)后其生存質(zhì)量顯著提高,甚至高于一般人群;同時術(shù)后患者癥狀控制越好,其生存質(zhì)量越高；術(shù)前生存質(zhì)量越差的患者,術(shù)后生存質(zhì)量改善程度越大；術(shù)后生理領(lǐng)域生存質(zhì)量隨患者年齡增大而降低。
[Abstract]:Background: as the medical model changes to the biological, psycho-social medical model, medical treatment not only targets the patient's body, but also includes the patient's energy and psychology caused by the disease and its treatment.Therefore, it is very important to evaluate the physical, psychological and social effects of disease and treatment on patients by evaluating health-related quality of life.Achalasia is a chronic progressive disease. Patients usually spend a lot of time, money and energy on the treatment of the disease.At present, there are a few studies on the improvement of quality of life in patients with achalasia after Heller's balloon dilatation, suggesting that these treatments can significantly improve the quality of life of patients with achalasia.This method synthesizes the characteristics of endoscopy and surgery. At present, the effect of rare POEM surgery on the quality of life of patients with cardia loss is studied, especially in China.Therefore, the purpose of this study was to investigate the effect of POEM on the efficacy and quality of life of achalasia patients.Objective: to evaluate the efficacy and quality of life of endoscopic myotomy in the treatment of achalasia.Methods: 35 patients with cardia achalasia were treated by endoscopic myotomy. The clinical efficacy was evaluated by Eckardt symptom score, gastroscopy and barium meal examination.At the same time, SF-36 was used to investigate and evaluate the quality of life (QOL) of patients.Results all 35 cases were successfully treated with POEM. The successful rate of operation was 100 and the average operation time was 55 minutes.The average length of tunnel was 14.1 cm, and the length of muscle incision was 10.6 cm.The birth rate was 1.5 / 35. The average follow-up was 6.4 months.The effective rate was 100 and there was no recurrence during the follow-up period, and the recurrence rate was 0.The mean scores of quality of life in all dimensions of the patients were lower than those of the norm before operation.Among them, there were significant differences in the dimension of RE4 between PFN and BPG, and the mean scores of QOL in the 8th dimension after operation were significantly higher than those in the corresponding dimension norm (P0.05 / 8), and in the physiological field, there was no significant difference in the quality of life (QOL) and physiological field (P 0.05).The average score in psychological field was significantly higher than that before operation (P 0.05), and the improvement rate of the score was negatively correlated with the score of preoperative dimension basis, and the score of Eckardt symptom was negatively correlated with the score of quality of life of each dimension at 1 month after operation.At 6 months after operation, the scores of Eckardt symptoms were only correlated with the scores of 5 dimensions and physiological domains, and the scores of psychological domain were negatively correlated with the scores of P0.05. the scores of quality of life in physiological domains were lower with the increase of age in the first and sixth months after operation (P 0.05).Conclusion 1.POEM is a safe and effective method for the treatment of achalasia. In the short term, it can significantly improve the clinical symptoms and the severity of esophageal dilatation.The quality of life of the patients with achalasia before operation was lower than that of the general population, and the quality of life after operation was significantly improved, even higher than that of the general population. At the same time, the better the symptom control was, the higher the quality of life was; the worse the quality of life was before operation, the better the quality of life was.The better the quality of life after operation, the lower the quality of life in physiological field with the age of patients.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R571

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