吹出肌肉切除术:在POEM和Heller肌肉切除术后出现的肌肉切除术后失败的新兴表型
Zaheer Nabi1, Mona Aggarwal2, Pradev Inavolu2
1Department of Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500082, India. zaheernabi1978@gmail.com.
Esophagus : official journal of the Japan Esophageal Society
|October 2, 2025
概括
爆发性肌肉切割 (BOM) 是治疗秋症后的一种结构性并发症,导致伪和复发性症状. 早期诊断和管理是改善肌肉切割手术后长期结果的关键.
科学领域:
- 胃肠病学 胃肠病学
- 手术并发症 手术并发症
- 食道运动障碍 食道运动障碍
背景情况:
- 吹出肌肉切除术 (BOM) 是腹腔镜赫勒肌肉切除术 (LHM) 和口腔内镜肌肉切除术 (POEM) 以后的一个未被认可的并发症.
- 在肌肉切割部位上,BOM呈现为伪,模仿治疗失败或其他异常.
研究的目的:
- 总结关于BOM的定义,病理生理学,诊断标准,临床相关性和治疗方法的当前知识.
- 要突出BOM发病率的越来越多的认可和潜在的低估,报告的发病率为18-30%.
主要方法:
- 多式诊断方法包括食管图,内镜,高分辨率计量仪和EndoFLIP.
- 放射学定义:远端食道直径增加>50%.
- 内镜检测结果:粘膜外囊或隔膜形成.
主要成果:
- BOM是肌肉切除术后晚期症状复发的重要因素,可能导致高达25%的POEM后失败.
- 一些BOM病例可能无症状,但许多病例表现为反复出现的消化不良,吐和食物停滞.
结论:
- 提高认识和标准化诊断标准对于早期BOM识别和适当干预至关重要.
- 管理是个性化的,从保守措施到重复做POEM,以分泌管切除或食道切除为重症病例.
- 新兴的工具,如FLIP泛度测量,可能会提高BOM的诊断准确性和治疗规划.
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