水流辅助经口内镜肌切开术与常规内镜切开术治疗贲门失迟缓症比较
近日，在DDW2012上，复旦大学附属中山医院普外科主任医师，副教授，内镜中心副主任周平红就胃肠道病变的内镜微创和外科手术治疗做了精彩演讲。本研究主要探讨水流辅助经口内镜肌切开术与常规经口内镜肌切开术比较节省了治疗时间，在出血、穿孔、肺气肿等并发症方面更安全。
编者按：近日，在DDW2012上，复旦大学附属中山医院普外科主任医师，副教授，内镜中心副主任周平红就胃肠道病变的内镜微创和外科手术治疗做了精彩演讲。感谢周平红教授接受金宝搏网站登录技巧 消化频道的约稿邀请，感谢周平红教授对本文的贡献。本研究主要探讨水流辅助经口内镜肌切开术与常规经口内镜肌切开术比较节省了治疗时间，在出血、穿孔、肺气肿等并发症方面更安全。
周平红教授做主题演讲
Water-jet assisted peroral endoscopic myotomy (POEM) in comparison to conventional endoscopic myotomy technique for treatment of esophageal achalasia
Li, Quan-Lin; Zhou, Ping-Hong; Yao, Liqing; Xu, Mei-Dong; Zhang, Yi-Qun; Zhong, Yun-Shi; Chen, Wei-Feng
Background:Peroral endoscopic myotomy (POEM) originally developed by Inoue et al. is shown to be effective as a lesser invasive but curative treatment for esophageal achalasia. POEM has not yet been standardized and it is like endoscopic submucosal dissection technically difficult and time consuming. These limitations may be reduced by the use of the new HybridKnife®(Erbe, Germany), combining high pressure water-jet for needleless submucosal injection and electrosurgical interventions like submucosal tunnelling and endoscopic myotomy of inner circular muscle bundles.
Aim:The primary aim of the study is to reduce the procedure time by water-jet assisted POEM in comparison to the conventional POEM procedure. The secondary aim is the procedure related safety in terms of bleeding, perforation and intraoperative emphysema.
Methods:Patients with esophageal achalasia were recruited at Zhongshan Hospital Shanghai, China. All procedures were carried out under general anesthesia with positive pressure ventilation. The study design is a prospective randomized controlled study. Conv. POEM was performed with the Olympus TT knife whereas for the water-jet assisted POEM the ERBE HybridKnife was used. Bleeding was initially treated electrosurgically or with hemostatic forceps or clips.
Results:43 patients (22f, median age 41.2[18-72]) were included. The length of the mucosa cut (HybridKnife: 3.5±0.7cm, conv. POEM:3.5±0.8cm,p=0.63) as well as the length of the circular muscle cut (HybridKnife:10.2±1.6cm, conv. POEM:10.9±0.9cm,p=0.07) was comparable between groups. The operation time was shorter for the HybridKnife group than for the conv. POEM group (21.8±7.1min vs. 36.9±10.0min,p<0.0001). The water-jet assisted group requires less replacements of instruments during operation (0.92±1.4 vs. 11.1±3.6). Injection volume was larger in the HybridKnife group (47.3±11.5ml vs. 33.2±8.8ml,p<0.0001). The HybridKnife group leads to a significantly lower bleeding rate (4.8±1.3 vs. 12.5±4.9,p<0.0001) and to a less frequent usage of coagulation forceps for treatment of intraoperative bleeding (0.96±1.4 vs. 2.4±2.5,p=0.045). The number of hemostatic clips was the same (HybridKnife:6.2±1.2, conv. 6.8±1.6). There were no perforations in both groups. No procedure needed surgical intervention. Cutaneous emphysema occurred in 1 case in the HybridKnife group and in 4 cases in the conv. group.
Conclusions:Water-jet assisted POEM with the HybridKnife lead to significantly shorter operation time, lower bleeding rate and a lower frequency of usage of coagulation forceps. The water-jet assisted procedure simplifies the POEM procedure and makes it safer. This clinical trial of 43 patients demonstrate that water-jet assisted POEM using the HybridKnife® is a serious alternative in terms of speed, complications and handling compared to the conv. POEM technique.
（复旦大学附属中山医院普外科主任医师，副教授，内镜中心副主任 周平红）
专题链接：2012美国消化疾病周专题
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