Salih Samo, Falak Hamo, Anand S Jain, Rushikesh H Shah, Vaishali Patel, Lucie F Calderon, Mengdan Xie, Parit Mekaroonkamol, Steven A Keilin, Qiang Cai
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引用次数: 0
Abstract
Purpose: Peroral endoscopic myotomy (POEM) after prior myotomy (PM-POEM) can be technically challenging with possible increased adverse events. We aimed to assess gas leak and mucosal injury incidence during PM-POEM, compared to an index POEM (iPOEM), and post-procedure extubation time.
Patients and methods: A retrospective study comparing PM-POEM to iPOEM from March 2016 to August 2018.
Results: There were 21 subjects in the PM-POEM and 56 subjects in the iPOEM. The PM-POEM group was younger (average age 44.33 vs 57.57 years, p=0.0082). Gas leak incidence did not differ between groups (28.6% in PM-POEM vs 14.3% in iPOEM, p=0.148). For cases with imaging available postoperatively, there was a trend towards higher incidence of gas leak in the PM-POEM, but it was not statistically significant (60% vs 42.1%, p=0.359). The post-procedure extubation time was not different between PM-POEM and iPOEM (11.38 vs 9.46 minutes, p=0.93), but it was longer when gas leak occurred (15.92 vs 8.67 minutes, p=0.027). The odds of mucosal injury were four-fold higher (OR, 4.31; 95% CI, 1.32-14.08), and more clips were used to close mucosal injuries (0.62 vs 0.14 clips, p=0.0053) in the PM-POEM group. More procedures were deemed difficult or challenging in the PM-POEM (33.3% vs 7.1%, p=0.007). The number of clips used to close the mucosotomy was not different between groups (4.05 vs 3.84 clips, p=0.498). Although the myotomy was shorter in PM-POEM, it was not statistically significant (6.38 vs 7.14 cm, p=0.074). However, the procedure was longer in PM-POEM (61.28 vs 45.39 minutes, p=0.0017). There was no intervention or ICU admission required pertinent to the procedure.
Conclusion: Performing PM-POEM can be more difficult with more mucosal injuries. Gas leak was associated with a slightly longer post-procedure extubation time, but clinical relevance is unclear given incidence of gas leak was unknown at time of extubation.
目的:在先前的肌切开术(PM-POEM)之后进行经口内窥镜肌切开术(POEM)在技术上具有挑战性，可能会增加不良事件。我们的目的是评估PM-POEM期间的气体泄漏和粘膜损伤发生率，与POEM指数(iPOEM)和术后拔管时间进行比较。患者和方法:2016年3月至2018年8月PM-POEM与iPOEM的回顾性研究。结果:PM-POEM共21例，iPOEM共56例。PM-POEM组更年轻(平均年龄44.33 vs 57.57岁，p=0.0082)。两组间气体泄漏发生率无差异(PM-POEM组为28.6%，iPOEM组为14.3%，p=0.148)。对于术后有影像学检查的病例，PM-POEM的气体泄漏发生率有升高的趋势，但差异无统计学意义(60% vs 42.1%， p=0.359)。PM-POEM与iPOEM术后拔管时间差异无统计学意义(11.38 vs 9.46 min, p=0.93)，但发生气体泄漏时拔管时间更长(15.92 vs 8.67 min, p=0.027)。粘膜损伤的几率高出4倍(OR, 4.31;95% CI, 1.32-14.08)， PM-POEM组使用更多夹子来闭合粘膜损伤(0.62 vs 0.14夹子，p=0.0053)。在PM-POEM中，更多的手术被认为是困难或具有挑战性的(33.3% vs 7.1%， p=0.007)。两组间用于关闭粘膜切开术的夹数无差异(4.05 vs 3.84夹，p=0.498)。虽然PM-POEM组的肌切开术较短，但差异无统计学意义(6.38 vs 7.14 cm, p=0.074)。然而，PM-POEM的手术时间更长(61.28分钟vs 45.39分钟，p=0.0017)。没有干预或ICU住院相关的程序要求。结论:黏膜损伤越严重，行PM-POEM越困难。气体泄漏与术后拔管时间稍长有关，但临床相关性尚不清楚，因为拔管时气体泄漏的发生率尚不清楚。
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