POEM治疗贲门失弛缓症术后并发症及复发的影响因素的研究

Study about the Factors Affecting the Recurrence and Postoperative Complications of POEM Treating AC

摘要: 目的：经口内镜下肌切开术自诞生以来，已逐渐成为治疗贲门失弛缓症的首选微创疗法，因其低复发率、较少副作用、微创的特点，得到了医生患者的广泛认可。但是关于该疗法术后短期复发及出现术后并发症的危险因素的研究却较少，本课题旨在通过分析于接受经口内镜下肌切开术治疗的贲门失弛缓症患者临床资料，筛选出可能的经口内镜下肌切开术复发和术后并发症的危险因素，以期对该术式的开展提供经验借鉴，帮助临床更好地解决患者的困难。方法：回顾性分析2012年1月~2019年12月在我院接受经口内镜下肌切开术治疗的所有贲门失弛缓症患者的临床资料，并采用电话随访的方式，了解患者术后情况。主要统计结果包括术后复发人数、未复发人数，出现术后并发症人数，并通过单因素和多因素分析评估复发及出现并发症的危险因素。在本课题中，定义术后6个月时随访者评定Eckardt评分大于3分为术后复发，术后6月时随访者评定Eckardt评分小于等于3分为未复发，选取胃食管反流作为主要研究的术后并发症，考虑患者不一定有较好的依从性，术后6个月以内反酸、烧心的胃食管反流的典型症状，作为出现术后并发症的标准。结果：在收集患者临床资料过程中，共纳入118例接受手术的患者作为研究对象，其中有100例随访随访成功，随访率为84.7% (100/118)。术后6个月时的Eckardt评分的平均值，由接受手术前的5.540下降为2.620，术后6个月时的Eckardt评分的中位数由术前5分降至3分。按照本课题的标准，在100例患者一共有12人出现术后复发，16人出现胃食管反流。根据取得的资料分析表明，Eckardt评分的高低与术后复发及出现胃食管反流显著相关。结论：经口内镜下肌切开术可以确实有效地缓解贲门失弛缓症患者的临床症状，改善患者的生活质量；分析表明术前Eckardt评分较高的患者出现术后复发和胃食管反流的风险更高。

Abstract: Objective: More and more patients in China and even in the world are receiving peroral endoscopic myotomy (POEM) to treat AC (achalasia cardia). However, there are few studies on the risk factors for short-term recurrence and postoperative complications after this therapy. The objective of this paper is to screen out possible risk factors for recurrence and postoperative complications of AC af-ter POEM by analyzing the clinical data of patients with AC who underwent POEM therapy. It is hoped that this paper can provide experience for the development of this surgery and help to better solve the difficulties of patients in clinical practice. Methods: The clinical data of all patients who suffered from AC and received POEM in our hospital from January 2012 to December 2019 were retrospectively reviewed, and the postoperative situation of the patients was investigated by tele-phone follow-up. The main statistical results included the number of patients with postoperative recurrence, the number of patients without recurrence, and the number of patients with postoper-ative complications. In addition, single and multiple factor analyses were performed to assess risk factors for recurrence and complications. In this paper, postoperative recurrence was defined as Eckardt score greater than 3 at 6 months after surgery, and no recurrence was defined as Eckardt score less than or equal to 3 at 6 months after surgery. GERD was selected as the main postopera-tive complication of the study. Considering that patients may not have good compliance, the typical symptoms of acid reflux and heartburn within 6 months after surgery were considered as the standard for postoperative complications. Results: In the process of collecting clinical data of pa-tients, a total of 118 patients who underwent the surgery were included in the study. Among all of them, 100 cases were successfully followed up, with a follow-up rate of 84.7% (100/118). The aver-age Eckardt score decreased from 5.540 before surgery to 2.620 at 6 months. The median Eckardt score decreased from 5 before surgery to 3 at 6 months. According to the criteria of this study, 12 of the 100 patients had postoperative recurrence and 16 had GERD. According to the data obtained, Eckardt score is significantly correlated with postoperative recurrence and GERD.