| Objective: To explore the clinical effect of peroral endoscopic myotomy(POEM)and the application value of salivary pepsin in the evaluation of postoperative gastroesophageal reflux disease.Methods: Collected during March 2020 to August 2020,in the Second Hospital,Hebei Medical University accept POEM of 51 patients with AC.All patients were confirmed by laboratory tests,endoscopy,electrocardiogram,High-resolution manometry and chest CT.Excluding the patients combining tumor in esophagus or cardia and significant heart or lung disease.Patients are:1)Effeciency evaluation: Eckardt score was uesd to know the postoperative clinical symptoms before and 3 months after surgery,understand the postoperative clinical symptoms change situation,evaluating the effect of postoperative.2)Analysis of postoperative complications: GERDQ scale and saliva pepsin analysis were performed before and 3 months after surgery to determine whether there were complicated gastroesophageal reflux.The age,gender,course of disease,esophageal pressure classification,BMI and other relevant instructional differences were compared between the reflux group and the non-reflux group.Multivariate Logisitic regression analysis was performed to analyze the independent risk factors affecting postoperative GERDResults:1.General information: The total number of patients was 51,including 29 males and 21 females;The patients were 19-74 years old,with an average age of(40±11)years old.Body mass index(BMI)indicated that 5 cases were underweight,30 cases were normal weight,5 cases were overweight.The course of disease ranged from 2 to 48 months,with a mean course of 2 years.Esophageal manometry: 20 cases of type I,24 cases of type II,7 cases of type III.2 patients had received balloon dilation before POEM,and none of the 51 patients had a family history of achalasia.20 cases had a history of smoking;22 cases had drinking history.2.Efficacy analysis: Follow-up time was 3 months.Symptoms were effective in 49 cases,treatment failure in 2 cases,the effective rate was 96%.The average preoperative Eckardt score of patients was(5.3±1.3)points,and the average postoperative Eckardt score was(0.9±1.0)points.Paired t-test was used to compare the preoperative and postoperative Eckardt scores,and the postoperative Eckardt score was significantly lower than the preoperativ.The difference was statistically significant.3.Postoperative gastroesophageal reflux: 6 cases(11.8%)of gastroesophageal reflux were diagnosed by GERDQ scale,and 10 cases(19.6%)of saliva pepsin were positive.The salivary protease is sensitive to the detection of acid reflux in the esophagus.Multivariate logistic regression analysis of age,gender,smoking history,alcohol consumption history,course of disease,BMI and High-resolution manometry classification showed that the above factors were not risk factors for gastroesophageal reflux after surgery.The patients with reflux were treated with standard dose of oral PPI,and the symptoms were significantly improved.Conclusion:1.Three months after POEM,the treatment effect of patients is obvious and the recurrence rate is low,which can effectively improve the clinical symptoms of patients and greatly improve their living standard.It can be used as one of the effective treatment methods for AC.2.The occurrence of gastroesophageal reflux disease 3 months after POEM.Pathological reflux may also occur in patients without symptoms of reflux.Age,sex,course of disease,BMI,smoking history,drinking history were not independent risk factors for postoperative gastroesophageal reflux. |
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