The clinical efficacy of POEM treating patient with achalasia of cardia and the observation for the risk factor of effecting curative efficacy / 中国医学装备

ABSTRACT

Objective:To analyze the clinical efficacy of POEM treating patient with achalasia of cardia and observe the risk factor of effecting curative efficacy.Methods: 66 patients with achalasia of cardia who were treated by using POEM were enrolled in this study, and series of indicators of esophagus dynamics including LESRP, LESP, LESRR and LESL were detected in pre and post operation. Clinical symptom score system(Eckardt score) of achalasia of cardia was adopted to evaluate the effect of surgical treatment for patients at the pre and post operation 7d, and the diameter of widest part of esophagus at pre and post operation 7d were detected. The incidence rate of pneumoderm, substernal ache, pulmonary infection, pleural effusion, tunnel bleeding, postoperative reflux and esophageal perforation and other complications were analyzed and the relative risk factors of effecting curative effect were observed.Results: The LESRP and LESP of patients with achalasia of cardia of post-operative 7d were significantly lower than that of pre-operative 7d(t=12.74,t=17.56,P<0.05), while the LESRR and LESL of post operative 7d were significantly higher than that of pre-operative 7d(t=9.10,t=14.86,P<0.05) , respectively. And the Eckardt score and widest diameter of post-operative 7d were significantly lower than that of pre-operation(t=19.49, t=7.83,P<0.05), respectively. Besides, the incidence rate of complication of patients in post-operation was 48.48％. As the results of Logistic regression, age, Chicago type and Ling type were the risk factors that affect curative effect of POEM for achalasia of chardia. And as the analysis, the prognosis was better when the patient's age was less than 60 years, Chicago II type and Ling type.Conclusion: POEM can significantly improve the indicators of esophagus dynamics, and the complication will be few and the curative effect will be exact in middle and short term of post-operation by using this method. Therefore, it is a safe and effective surgical mode.