Flush刀和SB刀在经口内镜下肌切开术治疗贲门失弛缓症中的临床应用

摘要

背景:经口内镜下肌切开术(POEM)目前已被广泛用于治疗贲门失弛缓症(AC)且效果显著.然而,POEM手术操作难度大,术后并发症发生率高.目的:探讨Flush刀和SB刀在POEM治疗AC中的有效性和安全性.方法:选取2013年4月-2017年4月武汉大学人民医院确诊为AC且接受POEM治疗的111例患者,将其分为Flush刀组、SB刀组和Dual刀组.比较三组手术相关指标、并发症和术后随访等方面的差异.结果:111例AC患者均顺利完成了POEM,三组平均手术时间、平均止血次数和平均更换设备的次数相比差异有统计学意义(P均＜0.05),进一步两两比较显示,Flush刀组和SB刀组上述手术相关指标均明显低于Dual刀组(P均＜0.05).三组术后并发症发生率相比差异有统计学意义(P=0.005),进一步两两比较显示,SB刀组显著低于Dual刀组(P=0.011),而Flush刀组与Dual刀组无明显差异(P=0.056).三组手术治疗成功率无明显差异(P＞0.05).结论:Flush刀和SB刀能有效缩短POEM治疗AC的手术时间,且其成功率与常规Dual刀相似.%Background:Peroral endoscopic myotomy (POEM) has been widely used in treatment of achalasia,and the efficacy is satisfactory.However,POEM is associated with high level of technical difficulty and high incidence of complications.Aims:To investigate the efficacy and safety of Flush knife and SB knife in POEM for treatment of achalasia.Methods:A total of 111 achalasia patients who had undergone POEM from April 2013 to April 2017 at Renmin Hospital of Wuhan University were enrolled,and were divided into Flush knife group,SB knife group and Dual knife group.Procedure-related parameters,complications,and follow-up data were compared among the three groups.Results:All the 111 patients underwent POEM successfully.The mean procedure time,mean frequency of hemostasis and mean frequency of device exchange were significant different among Flush knife group,SB knife group and Dual knife group (P all ＜ 0.05).Further comparisons showed that the above-mentioned procedure-related indices were significantly lower in Flush knife group and SB knife group than in Dual knife group (P all ＜ 0.05).The incidence of complications was significant different among the three groups (P =0.005).Further comparisons showed that incidence of complications was significantly lower in SB knife group than in Dual knife group (P =0.011),however,no significant difference was found between Flush knife group and Dual knife group (P =0.056).No significant difference in surgery success rate was found among the three groups (P ＞0.05).Conclusions:Flush knife and SB knife in POEM can shorten the procedure time and achieve similar success rate when compared with conventional Dual knife.