The Clinical Efficacy Of Peroral Endoscopic Myotomy In Treatment Of 44 Cases Of Achalasia

OBJECTIVE To investigate the safety and clinical efficacy of Peroral endoscopic myotomy(POEM)in the treatment of achalasia of cardia(AC).METHODS Retrospectively study of clinical data which selected from January 2012 to December 2017 in Ningxia Medical University General Hospital patients who diagnosed of achalasia and received treatment of POEM or thoracotomy Heller myotomy.Including: 1.General information: gender,age,nationality,course of disease,history of special treatment and other basic information;2.Operative data: operation date,time of operation,length of tunnel,length of muscle incision,intraoperative complications,postoperative complications,etc.3.hospitalization: postoperative hospitalization days,postoperative antibiotic use time,postoperative fasting time,total hospitalization expenses,etc.;4.follow-up.5.Comparison of efficacy with thoracotomy Heller myotomy: a total of 26 patientswho had no history of special treatment were selected from 2012.01 to 2015.12 patients.The group was divided into the POEM operation group(n = 14)and the thoracotomy Heller myotomy group(n = 12).Perioperative period data and follow-up data were analyzed to compare the efficacy of POEM and Heller myotomy.Results1.General information In this study,there were 44 patients,21 males and 23 females.The ratio of male to female was 1.095.Age rang from 15 to 73 years old,the average age is40 + 15 years old,and the peak age is 20 to 50 years old.The course of disease rang from 1to480 months,and the median course was 48 months.Chicago classification: I type 2 cases(8.7%),type II 21 cases(91.3%),type III 0 cases;There were 5 cases of special treatmenthistory,including 3 cases of expansion and 2 cases of stent implantation.2.Operation data Forty-four patients in our study successfully completed the surgery.The operative time was 66.9±11.5 min.The length of submucosal tunnel was 11.32±1.57 cm and the length of muscle dissection was 7.61 ± 2.40 cm.Intraoperative 2 cases of subcutaneous emphysema(4.5%),3 cases of perforation(6.8%),3 cases of pneumothorax(6.8%)and 3 cases of pneumoperitoneum(6.8%).Postoperative 5 cases of subcutaneous emphysema(11.4%),1 case of mediastinal gas(2.3%),1 case of pneumothorax(2.3%),2 case of pneumoperitoneum(4.5%),fever(9.0%).3.Efficacy analysis Followed-up time from 1 to 39 months.The clinical remission rates at postoperative 1 month,postoperative 3 month,and postoperative 6 month were 95.5%,95.2% and 94.9% respectively.The Eckardt score of postoperative 1 month decreased from preoperative(5.86±1.50)points to(2.05±1.40)points,the difference was very significant(P<0.0001).The Eckardt score of postoperative 3 month decreased from preoperative(5.83±1.50)points to(1.64±1.50)points,the difference was very significant(P<0.0001).The Eckardt score of postoperative 6 month decreased from preoperative(5.92±1.51)points to(1.72±1.54)points,and the difference was very significant(P <0.0001).4.comparison of efficacy between POEM and thoracotomy Heller myotomy(1)Comparison of perioperative related data: the operation time was 85.83±7.04 min in Heller myotomy group and 63.21± 5.70 min in the POEM group,and the difference was significant between the two groups(P=0.019).The POEM group was shorter than thoracotomy Heller myotomy group.Intraoperative blood loss was very significantly different(P < 0.0001),and the POEM group was significantly less than thoracotomy Heller myotomy group.Postoperative fasting time was very significantly different(P< 0.0001),and the POEM group was significantly shorter than the thoracotomy Heller myotomy group.Postoperative antibiotic use time was significantly different(P=0.016),and the POEM group was significantly shorter than thethoracotomy Heller myotomy group.There was no significantdifference in postoperative hospitalization time(P=0.470).There was no significant difference in hospitalization costs between the two groups(P =0.849).(2)Comparison of the treatment effect and safety: there was no significant difference in short-term efficiency between the two groups(P = 1.000).There was no significant difference in complication rates between the two groups(P = 0.692).Conclusion POEM can quickly relieve the clinical symptoms of patients with chalasia,short-term effect is sure,good safety.Compared with thoracotomy Heller surgery,POEM not only has the same effectiveness and safety,but also trauma,postoperative recovery fast.