| Objective(s):After prophylactic application of antibiotics in oral endoscopic myotomy(POEM),whether there are changes in postoperative body temperature,various infection indicators,and chest CT,and to explore the clinical effect of prophylactic application of antibiotics on postoperative infection in POEM.Methods: From January 2015 to July 2022,a total of 27 cases diagnosed as achalasia of the cardia and treated with POEM with complete clinical examination data were retrospectively analyzed,and the general data of the above patients(including gender,age,length of stay,Body mass index,duration of disease)were collected Relevant information on POEM(preoperative preparation,surgical time,whether mucosal injury and adhesion occur during surgery,myotomy length,preoperative Eckardt scores)and examination results(body temperature,white blood cell(WBC),neutrophil granulocyte count(NEUT),neutrophil count(NEUT%),interleukin 6(IL-6)Procalcitonin(PCT),C-reactive protein(CRP),chest CT and other data excluded patients with diabetes,hypoproteinemia,long-term preoperative use of immunosuppressive agents,preoperative signs of serious infection and surgical failure.The body temperature,white blood cells,neutrophil ratio,neutrophil count,IL-6,PCT,CRP,and chest CT findings of patients receiving POEM treatment after prophylactic antibiotics were analyzed for comparison and analysis.Results: A total of 27 patients diagnosed as achalasia and receiving POEM treatment were collected in this study.According to the results of comparing normal or abnormal preoperative and postoperative body temperature,white blood cells,neutrophil count,neutrophil ratio,procalcitonin,C-reactive protein,interleukin-6,and chest CT.1.There were 27 patients(100%)with normal preoperative body temperature and 5 patients(18.5%)with abnormal postoperative body temperature;Preoperative WBC values were normal in 25 patients(92.6%),abnormal in 2 patients(7.4%),normal in 21 patients(77.8%),and abnormal in 6 patients(22.2%);The preoperative NEUT value was normal in 25 patients(92.6%),abnormal in 2 patients(7.4%),normal in 22 patients(81.5%),abnormal in 5 patients(18.5%),normal in 24 patients(88.9%),abnormal in 3 patients(11.1%),normal in 18 patients(66.7%),and abnormal in 6 patients(33.3%);There was no statistically significant difference in body temperature,WBC,NEUT #,and NEUT% between the 27 patients before and after surgery(P>0.05).2.Due to the fact that only 6 patients had improved IL-6,PCT,and CRP before and after surgery,a comparative analysis of the above three indicators was performed in 6 patients before and after surgery: 5 patients had normal preoperative IL-6 values(16.7%),5 patients had abnormal IL-6 values(83.3%),4 patients had normal postoperative IL-6 values(66.7%),and 2 patients had abnormal IL-6 values(33.3%);Preoperative PCT values were normal in 5 patients(83.3%),abnormal in 1 patient(16.7%),normal in 5 patients(83.3%),and abnormal in 1 patient(16.7%);Preoperative CRP values were normal in 5 patients(83.3%),abnormal in 1 patient(16.7%),normal in 4 patients(66.7%),and abnormal in 2 patients(33.3%).There was no significant difference in IL-6,CRP,and PCT between pre and post operation in 6patients(P>0.05).The detection of IL-6,PCT,and CRP was completed in 27 patients after surgery,including 21 patients with normal IL-6(77.8%)and 6 patients with abnormal IL-6(22.2%);PCT was normal in 13(48.1%),abnormal in 14(51.9%);CRP was normal in15 patients(55.6%)and abnormal in 12 patients(44.4%).3.Only 13 patients completed chest CT before and after surgery.Comparative analysis of chest CT before and after surgery in 13 patients showed that 12 patients had normal chest CT before surgery(92.3%),1 patient had abnormal chest CT(7.7%),7 patients had normal chest CT after surgery(53.8%),and 6 patients had abnormal chest CT(46.2%).There was no statistically significant difference in CT results between 13 patients before and after surgery(P>0.05).A total of 17 patients completed chest CT after surgery,including 9 patients with normal chest(52.8%)and 8 patients with abnormal chest(47.1%).4.According to the preoperative Eckardt score,27 patients were graded for clinical symptoms,including 2 at level Ⅰ,15 at level Ⅱ,and 10 at level Ⅲ.Patients at level Ⅰ,Ⅱ,and Ⅲ were divided into groups.After comparative analysis,it was found that there were no statistically significant differences in postoperative body temperature,WBC,NEUT,NEUT%,IL-6,CRP,and PCT among patients with different Eckardt grades(P>0.05).There were 17 types of people who improved chest CT after surgery,including 0 at level Ⅰ,10 at level Ⅱ,and 7 at level Ⅲ.Comparative analysis showed that there was no statistically significant difference between preoperative Eckardt scores of level Ⅱ and level Ⅲ on postoperative chest CT(P>0.05).5.According to preoperative HRM manometry,there were 8 patients of type Ⅰ,19 patients of type Ⅱ,and 0 patients of type Ⅲ.There were no significant differences in postoperative body temperature,WBC,NEUT,NEUT%,IL-6,CRP,and PCT between type Ⅰ and type Ⅱ achalasia(P>0.05).Among the 17 patients who completed chest CT after surgery,4 patients had Type Ⅰ and 13 patients had Type Ⅱ.There was no statistically significant difference in chest CT between Type Ⅰ and Type Ⅱ patients with achalasia(P>0.05).6.According to the presence or absence of intraoperative mucosal damage,there were 4 patients in the mucosal damage group and 23 patients in the non mucosal damage group.The differences in postoperative body temperature,WBC,NEUT,IL-6,and CRP between the mucosal damage group and the non mucosal damage group were statistically significant(P<0.05),while the differences in postoperative NETU%and postoperative PCT between the two groups were not statistically significant(P>0.05).Among the 17 patients who completed chest CT after surgery,there were 4patients in the mucosal damage group and 13 patients in the non mucosal damage group.There was no statistically significant difference in chest CT between the two groups after surgery(P>0.05).7.According to the presence or absence of intraoperative mucosal adhesions,there were 4 patients in the group with mucosal adhesions and 23 patients in the group without mucosal adhesions.There was a statistically significant difference in postoperative CRP between the two groups(P<0.05),while there was no statistically significant difference in postoperative body temperature,WBC,NEUT,NEUT%,IL-6,and PCT between the two groups(P>0.05).Among the 17 patients with improved chest CT,there were 3 patients in the mucosal adhesion group and 14 patients in the non mucosal adhesion group.There was no statistically significant difference in chest CT between the two groups after surgery(P>0.05).8.The average surgical time in this study was 84 minutes,and was divided into groups based on greater than the average surgical time and less than or equal to the surgical time.There was no significant difference in postoperative temperature,WBC,NEUT,NEUT%,IL-6,CRP,and PCT between the two groups(P>0.05).Among the17 patients who improved chest CT after surgery,8 patients had surgery time>84minutes,and 9 patients had surgery time ≤ 84 minutes.There was no statistically significant difference between the surgery time and postoperative CT between the two groups(P>0.05).9.According to the myotomy length<6cm,≥ 6cm,there were 10 patients in the<6cm group and 17 patients in the ≥ 6cm group.There was no statistically significant difference in postoperative body temperature,WBC,NEUT,NEUT%,IL-6,CRP,and PCT between the two groups(P>0.05).Of the 17 patients who completed chest CT after surgery,8 were in the<6cm group and 9 were in the ≥ 6cm group.There was no statistically significant difference between the two groups in postoperative CT.Conclusion(s):1.After prophylactic application of antibiotics,inflammatory reactions may still occur after POEM.2.Mucosal damage or submucosal adhesions during POEM surgery are more likely to result in inflammatory reactions after surgery. |
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