| Object: Discuss the short-term clinical effect of peroral endoscopic myotomy(POEM)in the treatment of achalasia of cardia and the possible complications of POEM during and after operation.Methods:From June 2010 to May 2018,70 patients with achalasia of cardia confirmed by symptoms,signs,esophageal barium meal radiography and gastroscopy were selected to undergo peroral endoscopic myotomy.There were 29 males and 41 females.The patients ranged in age from 17 to 75 years with an average age(41.17 + 14.19)years.The shortest course of disease was 0.5 years,and the longest course was 27 years.The average duration was(15.22+5.70)years.The operation of peroral endoscopic myotomy is divided into the following steps:(1)Surface incision of esophageal mucosa to construct the entrance of tunnel.It is the best preparation for the next tunnel construction;(2)stripping the submucosa.The longitudinal tunnel under the mucosa was constructed;(3)all circular muscle bundles of the esophagus were separated under endoscopy;(4)Titanium clips were used to close the incision of the mucosa.After the operation,the time consumed during the operation,the complications during and after the operation and the time spent in hospital were recorded and counted.To evaluate the effect of treatment after operation.Results:Seventy patients with achalasia underwent peroral endoscopic myotomy in the central operating room.The whole process is very reasonable and the operation is correct.The operation went smoothly.The operation time was 30 minutes to 50 minutes,and the average time was(32.5+12.3)minutes.Four of these patients developed emphysema in the mediastinum and subcutaneous region,but they were absorbed spontaneously and recovered completely after operation.No furthertreatment is required.One week after the operation,it can gradually transit to a semi-liquid diet.If the recovery is still good as expected,the normal diet can be restored.Postoperative fever occurred in 6 cases.No complications such as delayed bleeding,esophageal fistula and mediastinal thoracic infection occurred.The shortest hospitalization time was 7 days and the longest was 12 days.The average hospital stay was 7.48 days.The patients were followed up for symptoms and related examination results.The efficacy of POEM is usually evaluated at the end of 4 weeks.The evaluation methods include the evaluation of subjective clinical symptoms and the evaluation of the results of objective auxiliary examinations.The subjective symptoms were assessed by Eckardt symptom score system and Henderson classification of esophageal dilatation.Generally speaking,Eckard's symptom score below 3 can be considered as an effective clinical treatment.The follow-up time was 1,6 and 12 months after surgery.The median follow-up time was 6 months after surgery.Follow-up included outpatient follow-up and telephone follow-up.Symptoms were alleviated after one month of operation,with 98.5%of the patients,accounting for 69 cases(69/70).Six months after operation,the remission rate was 88.5%(62/70).Preoperative and post-operative symptoms score,weight change and angiographic results were significantly better than before.Conclusions:Peroral endoscopic myotomy shows that the short-term outcome of the operation is better,especially for achalasia of cardia is safe and effective.However,there is still a certain probability of complications. |
PDF Full Text Request