重复口腔内镜肌肉切除:技术上的困难和风险因素
Li-Yun Ma1, Ke-Yi Guo1, Zu-Qiang Liu1
1Endoscopy Center and Endoscopy Research Institute, Shanghai Collaborative Innovation Center of Endoscopy, Zhongshan Hospital, Fudan University, Shanghai, China.
Gastrointestinal endoscopy
|November 18, 2024
概括
重复口腔内镜肌切除术 (Re-POEM) 是在初始口腔内镜肌切除术 (POEM) 后,治疗阿喀拉西亚的安全和可行的救援疗法. 重复POEM显示了与原始POEM相似的结果,具体因素预测了程序难度.
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
- 消化系统疾病管理管理
背景情况:
- 在口腔内镜肌切除术 (POEM) 后持续或复发的秋拉西亚症状需要救援治疗.
- 重复POEM (Re-POEM) 是一个潜在的选择,但可能会带来更多的技术挑战.
研究的目的:
- 评估Re-POEM的安全性和技术困难.
- 为了比较Re-POEM的结果与初始 (天真) 的POEM.
主要方法:
- 对接受Re-POEM的158名患者和接受POEM的2978名患者的回顾性分析 (2012年7月至2023年10月).
- 倾向性得分匹配 (PSM) 以创建可比的组.
- 与手术相关的参数的比较,包括手术时间,骨髓切割长度和不良事件 (AE).
- 多变量分析以确定难以重复POEM的风险因素 (程序时间≥90分钟).
主要成果:
- 在PSM之后,Re-POEM和原始POEM组的手术时间相似 (61.4±27.0分钟与59.3±29.9分钟).
- 重复POEM涉及更短的食道肌切除,但更长的胃肌切除长度.
- 粘膜损伤,与气体相关的副作用,主要的副作用和技术困难在各组之间是相似的.
- 粘膜和粘膜下纤维化被确定为困难的Re-POEM的独立风险因素.
结论:
- 对于初始POEM失败的患者来说,Re-POEM是一种安全和可行的救援疗法.
- 技术困难和不良事件的发生率与原始的POEM相比.
- 粘膜和粘膜下纤维化预测了Re-POEM程序中的挑战.
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