| Objective: To assess the efficacy and safety of the POEM in the treatment of AC in the elderly.Methods: A total of 77 patients diagnosed AC receiving POEM in the Affiliated Hospital of Qingdao University from January 2014 to May 2017 were retrospectively involved.The 25 patients aged 60 or older were assigned into group A(mean age 64.92 ±5.54)and 52 patients younger than 60 years old were divided into group B(mean age39.47 ± 11.99).There was no statistically significant difference between the two groups in ratio of male and female,BMI,course of disease,previous treatment condition,preoperative Eckardt score and esophageal pressure measurement(P>0.05).Patients in group A with concomitant diseases(including hypertension,diabetes,coronary heart disease,chronic lung disease)were significantly higher than those in group B,and the difference was statistically significant(P<0.05).The operation time,hospital stay,length of myotomy and intraoperative complications of the two groups,with the Eckardt score,esophageal pressure measurement and the long-term complications(mainly the gastroesophageal reflux related complications)of the two groups after POEM were followed up to analyze the safety and effectiveness of POEM in the treatment of AC in the elderly.Results: All the 77 patients successfully completed POEM surgery.(1)Esophageal pressure measurement 1 month after the operation in the two groups significantly decreased compared with that before the operation(P < 0.05),of which the postoperative average LES pressure in group A was(17.63±8.57)mmHg,and that in group B was(18.37±9.81)mmHg,and the difference between the two groups was not statistically significant(P>0.05).(2)After 1,6,12 and 24 months of follow-up,the Eckardt scores of group A were 0.91±1.05 points at 1 month after surgery,0.97±1.24 points at 6 months,1.15±1.21 points at 12 months,and 1.12±1.31 points at 24 months,and 1.02±1.22 points at 1 month after surgery,1.12±1.37 points at 6 months,1.09±1.26 points at 12 months,and 1.12±1.29 points at 24 months after surgery.The Eckardt scores of the two groups at any observation time after the operation were significantly inferior than those before the operation(P < 0.05),and there was no statistically significant difference between the twogroups at the same observation time point(P > 0.05).(3)Surgical failure and recurrence were regarded as ineffective treatment,and the therapeutic effective rate of each group was calculated accordingly.The operative effective rate at 1,6,12,and 24 months after surgery was compared between the two groups,and the difference was not statistically significant(P>0.05).(4)Intraoperative complications are similar in both groups(P > 0.05),including 6 cases(24.00%)of A group—subcutaneous emphysema in 3 cases,mediastinal emphysema in 1 case,pleural effusion in 1 case and mucous membrane perforation in 1case;14 cases(26.92%)of B group,among them 6 cases of subcutaneous emphysema,4cases of pneumomediastinum,2 cases of pleural effusion,2 cases of mucous membrane perforation.(5)On gastroesophageal reflux related complications,there are 9 cases of gastroesophageal reflux symptoms,including 2 cases of group A(8.00%),7 cases(13.46%)of group B,and the two groups has no statistical significance(P > 0.05),3patients were diagnosed as reflux esophagitis,1 case(4.00%)in group A and 2 cases(3.85%)of group B(P > 0.05).(6)The mean operation time of patients in group A was67.40±15.01 min,while that in group B was 64.74±10.37 min.There was no statistically significant difference between the two groups(P>0.05).The average length of muscle incision in group A was(9.20±1.83)cm,and that in group B was(9.07±2.02)cm.There was no statistically significant difference between the two groups(P>0.05).The average length of stay was 7.72±2.46 days in group A and 7.02±2.01 days in group B(P>0.05).There was no statistically significant difference between group A and group B(P>0.05).Conclusions: ?Both elderly patients and non-elderly AC patients can relieve their clinical symptoms effectively with POEM and the complications are rare.?The POEM is a safe and effective treatment in elderly AC patients and is expected to be the preferred method.However,it still needs a large sample multi-center study to prove it. |
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