| Objective To explore the clinical effect of open peroral endoscopic esophagectomy(O-POEM)in the treatment of achalasia.Methods The clinical data of patients with primary achalasia diagnosed in Ningxia Medical University General Hospital from January 2018 to December2020 and treated with O-POEM or traditional POEM were analyzed retrospectively.Including: 1.General information: age,sex,course of disease,history of previous special treatment,etc.;2.Surgical data: operation time,muscle incision length and operation-related complications;3.Hospitalization:postoperative hospitalization time,postoperative antibiotic use days and hospitalization expenses;4.Follow-up: Follow up the improvement of clinical symptoms in January,March and June after surgery by telephone or outpatient service;5.Forty-three AC patients treated with traditional POEM were compared with 26 AC patients treated with O-POEM,and the clinical and surgical data of the two groups were analyzed.Results1.General data: There were 26 patients in this study,including 12 males and14 females,ranging in age from 12 to 69 years,with an average age of(41.88±16.96)years.The course of disease ranged from January to 36 years,with an average course of(5.93±8.05)years.The preoperative Eckardt’s score ranged from 4 to 10,with an average score of(6.78±1.70).There were 5 cases with special treatment history,including 2 cases of Heller operation,2 cases of balloon dilatation and 1 case of traditional POEM1.2.Surgical data: All 26 patients in this group successfully completed the surgical treatment.The operation time was 19～50min,with an average of(33.00±9.79)min,and the myotomy length was 5～10cm,with an average of(7.48±1.57)cm.Intraoperative bleeding occurred in 1 case(3.8%)and perforation occurred in 2 cases(7.7%).Postoperative fever occurred in 2 cases(7.7%),inflammatory cells increased in 2 cases(7.7%),gas-related complications in 4cases(15.4%),localized pneumonia in 5 cases(19.2%)and pleural effusion in 4cases(15.4%).3.Hospitalization: the postoperative hospitalization days ranged from 4 to 14 days,with an average of(6.24±2.63)days,the postoperative antibiotic use time ranged from 3 to 13 days,with an average of(5.00±2.57)days,and the total hospitalization expenses ranged from 16,724.96 yuan to 39,278.84 CNY,with an average of(22339.81±5189.03)CNY.4.Analysis of curative effect: The remission rates of clinical symptoms were96.2%,95.8% and 95.7% respectively after 1 month,3 months and 6 months follow-up.The Eckardt’s score decreased from(6.78±1.70)before operation to(2.00±1.17)one month after operation,and the difference was statistically significant(P<0.001).The Eckardt’s score decreased from(6.75±1.62)before operation to(1.67±1.13)3 months after operation,and the difference was statistically significant(P<0.001).The Eckardt’s score decreased from(6.65±1.58)before operation to(1.78±1.00)6 months after operation,and the difference was statistically significant(P<0.001).5.There was no significant difference in age,course of disease and Eckardt’s score before operation between the two groups(P>0.05).Compared with traditional POEM,the operation time of O-POEM is greatly shortened(P<0.001),and the operation time of O-POEM is shorter for patients with submucosal fibrosis(P<0.001).Conclusion1.O-POEM can effectively improve the clinical symptoms of patients with achalasia,the short-term curative effect is accurate,and the operation time is short.2.For achalasia patients with submucosal fibrosis,O-POEM may be a better choice. |
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