| Objective Peroral endoscopic myotomy(POEM),as an emerging minimally invasive endoscopic technique for the treatment of achalasia(AC),has been more and more widely used in the world since its inception in 2008.With the widespread development of POEM in clinical practice,the operation procedures of POEM tend to be diversified.The different tunnel opening methods will directly affect the operating results,but the clinical efficacy of the specific opening methods is not very clear.This article intends to evaluate the safety and effectiveness of different tunnel opening methods by comparing the clinical efficacy of two different tunnel opening methods POEM treatment of AC patients with longitudinal opening method and inverted "T" opening method.Methods The clinical data of 55 patients with AC who underwent POEM treatment at Yantai Yuhuangding Hospital,Qingdao University from January2016 to December 2019 were retrospectively analyzed,including the general conditions of the patients(gender,age,course of disease,length of stay(LOS),operation time,previous related treatment history,etc.),clinical symptom scoring system for achalasia of cardia(Eckardt score),the occurrence of intraoperative and postoperative short-term complications(gas-related complications,mucosal injury,bleeding,etc.).Through the use of statistical software for specific data analysis,we can obtain comparable quantitative data and analyze the statistical significance of its representatives.Results A total of 55 patients with AC who underwent POEM treatment at Yantai Yuhuangding Hospital were enrolled in this study,including 29 cases in the longitudinal opening method group(16 males and 13 females),and 26 cases in the inverted "T" opening method group(7 males and 19 females),aged 18 to 77 years old,course of disease was 1 week to 25 years.Before the operation,6 patients had received other treatments related to AC and all were treated by electronic endoscopic balloon dilatation,including 2 cases in the longitudinal opening method group and 4 cases in the inverted "T" opening method group.All 55(55/55,100%)patients successfully completed POEM,with an average LOS of 10.67±2.80 days.The postoperative Eckardt scores were all ≤3.The postoperative clinical symptoms of the two groups of patients were all significantly improved compared with before(2(2,2)vs 4(4,5)),P< 0.05),and the overall symptom relief rate was 98.2%(54/55).The two groups of patients selected in the study had no statistically significant differences in general clinical data such as age,course of disease,length of stay,operation time,preoperative Eckardt score,postoperative Eckardt score,etc(P > 0.05).A total of 17(17/55,30.9%)patients experienced operating complications,including 13(13/29,44.8%)cases in the longitudinal opening method group,and 10 cases(10/29,34.5%)with gas-related complications,fever(body temperature > 38.0℃)in 2 cases,severe chest and abdomen pain in 2 cases,gastric fundus mucosa laceration and bleeding and gastrointestinal perforation in 1 case,postoperative recurrence in 1 case;inverted "T" opening method group had 4 cases(4 /26,15.4%)with operating complications,of which 2 cases were gas-related complications(2/26,7.7%),1 case had fever,and 1 case had postoperative bleeding.There are patients with more than one type of complication,and the above complications are all improved after timely treatment during the operation and follow-up medical conservative treatment.The data showed that the total complication rate of the longitudinal opening method group was markedly higher than that of the inverted "T" opening method group(44.8%(13/29)vs 15.4%(4/26),P < 0.05),the incidence of gas-related complications was more obvious(34.5%(10/29)vs7.7%(2/26),P < 0.05).Although both groups of patients were successfully operated on,compared with the postoperative curative effect and short-term complications,the safety of the operation in the inverted "T" opening group were higher.Conclusion The inverted "T" opening method POEM can not only effectively relieve the clinical symptoms of patients,but also reduce the incidence of short-term complications during and after operative treatment.Significance This study collected patients with AC who underwent POEM treatment at Yantai Yuhuangding Hospital,and compared the clinical efficacy of longitudinal opening method and inverted "T" opening method in treatment of patients with AC by peroral endoscopic myotomy(POEM)through intraoperative and postoperative complications.It is hoped that it will help the selection of effective treatment options with POEM technology in the future to improve the prognosis and quality of life of patients with achalasia. |
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