Comparison Of Efficacy Of Endoscopic Sphincterotomy And Surgical Treatment For Achalasia Of Cardia

Objective:To compare the therapeutic effects of peroral endoscopic myotomy and surgical treatment for achalasia of cardia.Methods:1.This study retrospectively analyzed the relevant clinical symptoms(dysphagia,chest pain,reflux,weight loss,etc.)from the relevant hospitals in Northeast Sichuan from 2014 to 2019.The esophageal barium meal and gastroscopy were confirmed as Cardiac achalasia.The age,gender distribution,duration of disease and perioperative period of 40 patients receiving POEM surgery were analyzed.The postoperative follow-up of the patients for 1 month,3 months and 6 months,as well as the incidence of related complications,was conducted to compare and analyze the therapeutic effect of POEM surgery.2.In this study,12 patients who received POEM surgery at the Affiliated Hospital of North Sichuan Medical College were selected and compared with 11 patients who underwent thoracotomy Heller operation group.The perioperative data and follow-up results of the two groups were counted.analysis.Results:1.General information:A total of 40 patients underwent POEM surgery,including 18 males,45%of the total,and 22 females,55%of the total.The ratio is 1:1.222;40 patients range in age from 13 to 75 years,and the average age reached is 40 years old,and most patients are concentrated between 20 and 50 years old.Depending on the physical characteristics of each patient,the duration of the disease will also be different,usually ranging from 1 month to 40 years,and the median duration of the disease is 50 months.Of these 40 patients,6 had a history of special treatment,3 had undergone dilatation,and 3 had stent implantation.2.Surgical data:All 40 patients received POEM surgery,and the operation process was very smooth.The entire surgical procedure lasted 65.5±10.3 minutes,the length of the submucosal tunnel was 11.21±1.54 cm,and the length of the myotomy was 8.23±2.37 cm.During the operation,there were 2 cases of subcutaneous emphysema,accounting for 4.5%of the total number of patients.There were 2 cases of perforation,accounting for 5%.There was 1 case of pneumothorax,accounting for 2.5%.One case of pneumoperitoneum occurred,accounting for 2.5%.After the completion of the operation,the symptoms of the patients were as follows:3 cases of subcutaneous emphysema,accounting for 7.5%;Mediastinal gas accumulation occurred in 1 case,accounting for 2.5%.There was 1 case of pneumothorax,accounting for 2.5%.Pneumoperitoneum occurred in 1 case(2.5%)and fever in 3 cases(7.5%).3.Efficacy analysis:After the operation is completed,Patients were followed up.The results found that:One month after the POEM operation,Eckardt test was performed,and its score changed from(5.84±1.51)before the operation to(2.04±1.41),which showed a significant downward trend(p<0.0001);Three months after the POEM operation,the Eckardt test was performed,and its score changed from(5.82±1.49)before the operation to(1.63±1.50),showing a significant downward trend,and the difference was significant The coefficient is p<0.0001;6 months after the operation,the Eckardt test was performed,and its score changed from the previous(5.90±1.50)to(1.70±1.53),which also showed a significant downward trend,which showed The coefficient is p<0.0001.4.Compare the diagnosis and treatment effect between the POEM operation group and the open chest Heller operation group(1)Comparison of perioperative data:The duration of the operation:85.81±7.03 min in the openchest Heller operation;63.20±5.70 min in POEM operation.After comparison,the significant difference coefficient p is 0.019,indicating that the POEM treatment group had an advantage from a time-consuming point of view.Comparison of bleeding volume during surgery:After comparison,the difference coefficient p obtained was less than 0.0001.From the perspective of bleeding volume,the POEM treatment group was significantly less.Comparison of postoperative fasting time:after comparison,the difference coefficient p obtained is less than 0.0001.From this perspective,it is obvious that the fasting time of the POEM treatment group is shorter after the operation.Postoperative antibiotic use duration comparison:After comparison,the difference coefficient pis 0.016.From this perspective,it is obvious that the antibiotic use duration of the POEM treatment group is shorter after surgery.Comparison of postoperative length of hospital stay:According to the difference coefficient obtained,the significance coefficient p is 0.470,which has no statistical significance.Comparing the hospitalization costs incurred by the two groups,according to the difference coefficient obtained,the significance coefficient pis 0.849,which was not statistically significant.(2)Compare from the perspective of diagnosis and treatment efficacy and safety:in the same short period of time,it is more effective to compare which kind of surgery is performed.The significant difference coefficient p obtained from the difference is 0.984,which is statistically There is no specific meaning.The concurrency rate it will produce is the same as the result obtained statistically.Conclusion:POEM can produce ideal therapeutic effects on achalasia,and it can be manifested in a short time,and the safety it implements is also guaranteed.After comparing with the open chest Heller operation,it will be found that in addition to the advantages of the same effect and high safety,POEM surgery also has the advantages of less trauma and quick recovery after surgery.