摘要
目的探讨贲门失弛缓症（AC）行经121内镜下肌切开术（POEM）治疗发生气体相关并发症的原因及适宜的处理措施。方法2010年12月至2015年7月间，解放军总医院390例行POEM治疗的AC患者的临床资料纳入回顾性研究，汇总气体相关并发症的发生情况、处理方法及转归，并采用单因素和多因素分析的方法对并发气体相关并发症的原因进行分析。结果55例（14．10％，55／390）发生气体相关并发症（存在伴发情况），其中气胸4例（1．03％，4／390）、气腹29例（7．44％，29／390）、皮下气肿23例（5．90％，23／390）、贲门撕裂7例（1．79％，7／390），经保守治疗或穿刺排气或胸腔闭式引流后均痊愈出院。单因素分析发现，POEM隧道长度（r=6．209，P=0．045）、肌切开深度（x2=12．354，P=0．002）、手术时间（x2=54．905，P=0．000）及AC治疗史（x2=16．920，P=0．000）是POEM治疗AC发生气体相关并发症的危险因素；进一步多因素分析证实，AC治疗史（OR：4．150，95％CI：1．875-9．193）、POEM隧道长度（OR：2．410，95％CI：1．148—5．063）、POEM手术时间（OR=4．750，95％CI：2．196～10．283）是POEM治疗AC发生气体相关并发症的独立危险因素。结论POEM治疗AC易发气体相关并发症，既往曾行AC治疗者尤应警惕。术中应采取保护性通气，尽可能缩短隧道长度和手术时间，并全程应用CO2气泵。一旦发生，及早发现并及时处理是保证手术安全的关键。对于少量积气一般无需特殊处理；若发现严重的气胸及气腹，应立即行穿刺排气。
Objective To investigate the causes and treatment of gas-related complications during peroral endoscopic myotomy（POEM） for achalasia（AC）. Methods Retrospective analyses were performed on the clinical data of 390 AC patients receiving POEM at Chinese PLA General Hospital from December 2010 to July 2015.Univariate and multivariate analyses were conducted for potential risk factors and treatment for gas-related complications. Results Gas-related complications occurred in 55 （ 14. 10%, 55/390） cases. There were 4 （ 1.03%, 4/390） cases of pneumothorax, 29 （ 7.44%, 29/390） cases of pneumoperitoneum, 23 （5.90% ,23/390）subcutaneous emphysema and 7（ 1.79% ,7/390） cardia avulsion during POEM. All gas- related complication were ,cured by conservative therapy, deflation by puncture or closed drainage of chest cavity.Univariate analysis revealed that tunnel length （X2 = 6. 209, P = 0. 045 ）, myotomy depth （X2 = 12. 354, P = 0. 002）, operation time （X2 = 54. 905, P = 0. 000） and previous therapies （X2 = 16. 920, P = 0. 000 ） were risk factors for gas-related complications. Muhivariate analysis indicated that previous therapies （OR = 4. 150, 95%CI： 1. 875-9. 193 ）, tunnel length （ OR = 2. 410,95% CI： 1,148-5.063 ）, operation time （ OR = 4.750, 95%CI： 2.196-10.283 ）were risk factors for gas-related complications for AC during POEM. Conclusion Gas-related complications occurred frequently during POEM, especially for patients with previ-ous therapies of AC. Tunnel length and operative time should be shortened as much as possible. Protective ventilation and CO2 pump should be employed during the whole POEM procedure. Mild complications, pres- ented with merely a small amount of subcutaneous emphysema, do not require any special intervention. If se- vere pneumoperitoneum and pneumothorax occur, puncture should be applied immediately.
出处
《中华消化内镜杂志》
北大核心
2016年第7期437-441,共5页
Chinese Journal of Digestive Endoscopy
关键词
食管失弛症
治疗应用
经口内镜下肌切开术
手术后并发症
Esophageal achalasia
Therapeutic Uses
Peroral endoscopic myotomy
Postoper-ative complications
