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在"POEM时代"的阿喀拉西亚肺部扩张:仍然是一个有价值的盟友

Edoardo Vespa¹, Alberto Barchi², Sandro Passaretti¹

¹Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy.

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver

|November 6, 2023

概括

肺部扩张 (PD) 是一种安全有效的内镜治疗,特别是对于优先考虑食道完整性的患者. 口腔内镜肌切除术 (POEM) 提供高疗效,但带有更高的风险,使得PD成为一个有价值的替代方案.

科学领域:

胃肠病学胃肠病学
最少侵入性的手术
食道运动障碍食道运动障碍

背景情况:

阿哈拉西亚是一种罕见的食道运动障碍,其特点是食道下部关节的放松受损和周围静止的丧失.
内镜治疗,包括气动扩张 (PD) 和口腔内镜肌切除术 (POEM),是阿喀拉西亚的主要治疗选择.
POEM因其有效性而受到欢迎,但其复杂性和潜在的长期并发症需要仔细考虑.

研究的目的:

为了比较气动扩张 (PD) 和口腔内镜肌切除术 (POEM) 的疗效和安全性,用于治疗阿哈拉西亚.
为了评估PD和POEM适合不同患者群体和achalasia亚型的适合性.
强调个性化,针对患者的方法在选择最佳的内镜治疗阿喀拉西亚时的重要性.

主要方法:

这篇叙述性综述综合了关于PD和POEM疗效和安全性的当前证据.
对程序结果,并发症率和长期结果的比较分析.
讨论影响治疗选择的患者特定因素.

主要成果:

POEM 显示出高效率,特别是在III型阿喀拉西亚,但涉及更高的复杂性和潜在的长期风险.
PD是一种有价值的替代方案,特别是对于非扩张食道的患者来说,它可以保护解剖完整性并降低GERD的风险.
对于GERD而言,PD具有有利的安全概况,并且永久性食道变形的风险最小,并且有可能重复手术.

结论:

在PD和POEM之间选择阿喀拉西亚应该是个性化的,权衡每个程序的好处和缺点.
尽管POEM的兴起,PD仍然是一个关键和有价值的选择,在内镜治疗武器库的阿喀拉西亚.
需要进一步的研究来完善治疗策略,并解决关于长期结果的剩余问题.

关键词:

亚哈拉西亚亚哈拉西亚是指亚哈拉西亚地区.格尔德 (GERD) 是一个很好的朋友.口腔内镜肌肉切除术 (peroral endoscopic myotomy) 是一种口腔内镜肌肉切除术.气动扩张的气动扩张

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