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与口腔内镜肌肉切除相关的因素:系统性审查和元分析
Yajun Shou1,2,3, Xiandi Wang1,2,3, Deliang Liu4,5,6
1Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China.
Surgical endoscopy
|May 23, 2024
概括
门内镜肌切除术 (POEM) 在阿喀拉西亚患者中的失败与西格食道,特定的测量器亚型 (I和III) 以及先前的治疗方法 (如Heller肌切除术或气球扩张) 有关. 第二种类型的阿哈拉西亚显示出更好的POEM响应.
科学领域:
- 胃肠病学 胃肠病学
- 内視鏡外科手術 內視鏡外科手術
- 手术结果研究研究.
背景情况:
- 口腔内镜肌切除术 (POEM) 是治疗阿喀拉西亚的关键方法,但成功率各不相同.
- 确定预测POEM失败的因素对于患者管理至关重要.
- 十多年的临床实践揭示了POEM失败的潜在预测因素.
研究的目的:
- 系统地审查和综合有关POEM失败的风险因素的证据.
- 提供对影响POEM.成功的因素的全面分析.
- 为了指导临床决策的阿喀拉西亚治疗.
主要方法:
- 在主要数据库 (PubMed,Embase,Web of Science,Cochrane Library) 进行系统的文献搜索,截至2022年6月.
- 包括英语研究报告POEM结果和失败风险因素在achalasia.
- 使用固定或随机效应模型进行元分析,以聚合效应大小.
主要成果:
- 对27项涉及9371名阿喀拉西亚患者的研究的分析显示,POEM失败率为8%.
- 西格性食道 (OR 1.90) 和类型I (OR 1.30) 和III (OR 1.26) 的阿喀拉西亚与更糟糕的结果有关.
- 之前的Heller骨髓切割 (OR 5.75) 和气球扩张 (OR 1.18) 增加了POEM失败的风险,而II类 achalasia显示出更好的反应 (OR 0.59).
结论:
- 西格管食道,特定的测量力学的亚型,以及之前的治疗是POEM失败的显著预测因素.
- 了解这些风险因素可以帮助优化POEM的成功率.
- 这些证据支持在接受POEM的阿喀拉西亚患者的知情治疗选择.
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