内镜注水泵与注射针用于贲门失弛缓症经口内镜下肌切开术治疗的对比研究（含视频）

Comparison between water-jet and needle for submucosal injection in peroral endoscopic myotomy for treatment of patients with achalasia (with video)

摘要:

行黏膜下注射的效果和安全性。 方法 2013年3月至2016 年2月，中国人民解放军陆军总医院消化内科126例行POEM治疗的AC患者纳入回顾性研究，对比分析POEM治疗术中使用内镜注水泵（注水泵组，n=73）和内镜注射针（注射针组，n=73）行黏膜下注射建立隧道用时、整个手术用时以及2组并发症的发生情况。 结果 注水泵组建立10～14 cm隧道用时（6.38±0.94）min，注射针组为（13.81±1.13）min，2组间差异有统计学意义（P<0.05）。注水泵组手术用时（27.81±5.76）min，注射针组为（70.25±22.67）min，2组间差异有统计学意义（P<0.05）。注水泵组术后住院时间为（4.38±1.87）d，注射针组为（5.64±1.83）d，2组间差异有统计学意义（P<0.05）。注水泵组出血发生率[5.48%（4/73）比16.98%（9/53）]、发热发生率[12.33%（9/73）比26.42%（14/53）]均低于注射针组（P<0.05），穿孔、胸痛发生率2组间比较差异均无统计学意义（P>0.05）。 结论 POEM治疗AC过程中使用内镜注水泵替代内镜注射针行黏膜下注射安全、有效，可以有效缩短建立黏膜下隧道用时及手术用时，同时减少出血、发热等并发症的发生。

Abstract:

Objective To evaluate the efficacy and safety of submucosal injection using endoscopic water-jet in peroral endoscopic myotomy (POEM) for treatment of patients with achalasia of cardia (AC). Methods A retrospective analysis was performed on the data of 126 AC patients undergoing POEM in PLA Army General Hospital from March 2013 to February 2016. All the 126 patients were divided into two groups, 73 in the water-jet group and 53 in the needle injection group. The time to creating a submucosal tunnel, entire operation time, and incidence of complications were compared between the two groups. Results The time to creating a submucosal tunnel and the entire operation time of the water-jet group were both significantly less than those of the needle injection group (6.38±0.94 min VS 13.81±1.13 min, P<0.05; 27.81±5.76 min VS 70.25±22.67 min, P<0.05). The hospital stay of patients after operation was less in the water-jet group than that in the needle injection group (4.38±1.87 days VS 5.64±1.83 days, P<0.05). The incidence of bleeding [5.48% (4/73) VS 16.98% (9/53), P<0.05] and fever [12.33% (9/73) VS 26.42% (14/53), P<0.05] were lower in the water-jet group than those in the needle injection group. The incidences of perforation and pectoralgia were not significantly different between the two groups (both P>0.05). Conclusion Using endoscopic water-jet injection is safe and effective in POEM, which effectively shortens the time to creating a submucosal tunnel and the operation time, and reduces the incidences of complications including bleeding and fever.