| Objective: To compare the differences between the modified peroral edoscopic myotomy(Liu-POEM)and the traditional endoscopic myotomy in the treatment of achalasia.Methods: To collect the patients with cardia,which was admitted by the affiliated hospital of Qingdao university medical from 2015-2017.According to the different surgical methods,42 cases of POEM operation group and 27 cases of Liu-POEM operation group were collected.According to the different operation methods,the patients were divided into traditional POEM group and Liu-POEM group.Among them,42 cases belonged to traditional POEM group while 27 cases contained in Liu-POEM group.Those two groups were compared with each other in terms of postoperative effect,length of operation time,complications(fever,hematologic abnormality,pleural effusion,reflux esophagitis),time length of admission and other aspects,to observe the differences between them.Results:(1)The score of conventional POEM group(preoperative Eckardt score vs after 1 month of surgery)was(6.86 ± 1.79 vs 0.64 ± 1.34),and LES pressure(pre-operation vs 1 month after surgery)was(41.99±7.20 vs 16.83±2.72 mm Hg);while Liu-POEM group Eckardt scored(pre-operation vs 1 month after surgery)was(7.11±1.93 vs 0.70 ± 1.41),and LES pressure(pre-operation vs 1 month after surgery)was(44.24 ± 8.68 vs 15.94 ± 2.58)mmHg,and four groups of data were all statistically significant(P<0.05).(2)The Eckardt score of the traditional POEM group was(0.64±1.34)after one mouth of surgery,and the Eckardt score of the Liu-POEM group was(0.70±1.41)after one mouth of surgery.The difference was not statistically significant(P > 0.05).The LES pressure of the traditional POEM group was(16.83±2.72)mmHg after one month of operation,The LES pressure of the liu-POEM group was(15.94 ±2.58)mm Hg after one month of operation.The difference was not statistically significant(P > 0.05).The Eckardt score of the traditional POEM group was(0.76±1.48)after six months of surgery,and the Eckardt score of the Liu-POEM group was(0.74±1.58)after six months of surgery.The difference was not statistically significant(P > 0.05).TheLES pressure of the traditional POEM group was(17.01±4.61)mmHg after one month of operation,The LES pressure of the liu-POEM group was(16.91±4.92)mmHg after one month of operation.The difference was not statistically significant(P > 0.05).(3)Half a year after the surgery,those two groups of patients with a total of 3 people presented difficulty in swallowing,regurgitation of food and other symptoms,and Eckardt scored more than 3 points.Considering the recurrence,the recurrence rate of POEM group was(2,4.8%),of Liu-POEM group the recurrence rate was(1 person,3.7%),and the difference was not statistically significant(P > 0.05).The average days of hospitalization in the conventional POEM group and the Liu-POEM group were(7.24 ± 0.93vs7.48± 1.16)days,and the difference was not statistically significant(P>0.05).(4)The operation time of Liu-POEM group was(39.63 ± 11.60),and the operation time of the traditional POEM group was(69.57 ± 18.08)? The difference was statistically significant(P < 0.05),and the operation time of Liu-POEM group was significantly shorter than that of the traditional POEM group.(5)The incidence of gas related complications in Liu-POEM group was significantly lower than that in POEM group[(12cases,28.6%)vs(2 cases,7.4%)],and the difference was statistically significant(P<0.05).(6)Comparing the occurrence rates of postoperative fever [(4 cases,9.5%)vs(1 case,3.7%)],blood abnormalities [(2 cases,4.8%)vs(2 cases,3.7%)],pleural effusion [(5cases,11.9%)vs(3 cases,11.1%)],reflux esophagitis [(4 cases,9.5%)vs(4,14.8%)] and complications between the conventional POEM group and the Liu-POEM group,and there was no statistically significant difference(P>0.05).(7)The average length of hospitalization in the traditional POEM group was(7.24 + 0.93),and the average length of hospitalization in the Liu-POEM group was(7.48 + 1.16),with no statistically significant difference(P>0.05).Conclusion:(1)Both the traditional POEM and the Liu-POEM can significantly relieve the clinical symptoms of achalasia of cardia,and there was no significant difference in the short-term curative effect and recurrence rates between the two methods.(2)Compared with the traditional POEM,the operative time and gas-related complications of the Liu-POEM were significantly reduced.(3)there was no significant difference in postoperative fever,abnormal hematology,pleural effusion,reflux esophagitis and days of admission between the traditional POEM and the Liu-POEM. |
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