通过口腔内镜肌肉切除过程中食道阻抗平面测量指导肌肉切除的程度
Ali M Kara1, A J Haas1, Hemasat Alkhatib2
1Department of Surgery, The MetroHealth System, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.
Surgical endoscopy
|July 23, 2024
概括
功能性光线成像探针 (FLIP) 技术在阿喀拉西亚的口腔内镜肌切除术 (POEM) 期间客观地测量了下缩管 (LES) 几何状况. 术内FLIP使用指导肌瘤的程度,改善患者的结果,并可能降低GERD风险.
科学领域:
- 胃肠病学和内镜检查
- 外科技术评估的外科技术评估.
- 食道运动障碍 食道运动障碍
背景情况:
- 口腔内镜肌切除术 (POEM) 是治疗阿哈拉西亚的标准治疗方法.
- 功能性光线成像探针 (FLIP) 技术可以客观地测量下食道 (LES) 几何状况.
- 现有文献表明,特定的FLIP值与改善的POEM后结果相关.
研究的目的:
- 评估FLIP技术在POEM期间评估肌肉切除的程度的内科实用性.
- 为了将手术内FLIP测量与POEM后症状改善相关联.
- 评估FLIP指导肌肉切除术对患者结果和潜在并发症 (如GERD) 的影响.
主要方法:
- 用手术内FLIP测量进行POEM的患者的回顾性分析 (2020年6月 - 2023年1月).
- 主要终点包括手术内FLIP测量,随后的管理变化和通过Eckardt评分评估的症状改善.
- FLIP测量 (延伸度指数和直径) 在肌肉切割前和后记录.
主要成果:
- 在外科手术期间的FLIP显示,肌肉切割后的LES延伸度指数和直径显著增加 (p < 0.05).
- 一名患者需要根据不充分的FLIP值进行额外的肌肉切除;没有发生手术内并发症.
- 在30天的随访时,78%的患者的埃卡德得分≤2,表明症状有显著改善;75%的复发被FLIP识别出来.
结论:
- 术内FLIP技术支持POEM手术的疗效,大多数患者在标准肌肉切除术后达到最佳的 LES 几何.
- FLIP的指导方针可能允许缩短肌肉切割,可能达到类似的结果,同时降低术后GERD风险.
- 对于未来的前性试验和比较分析,建议对研究设计和结果措施进行标准化.
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