摘要目的 探讨1 940 nm铥激光在贲门失弛缓症( AC)经口内镜下肌切开术( POEM)治疗中的有效性及安全性.方法 运用Zelen设计的方法,将2016年2月1日至2016年11月30日就诊于北京友谊医院消化内科,且无POEM操作禁忌证的15例患者分为2组,分别用1 940 nm铥激光(铥激光组)和高频电刀(高频电刀组)行POEM治疗,并随访3个月,比较2组在操作时间、成功率、疗效及并发症方面的差异.结果 15例患者的手术均顺利完成. 2组基线资料差异无统计学意义( P＞0. 05),在总操作时间、建立隧道时间、肌层切开时间、封闭切口时间方面差异均无统计学意义( P＞0. 05),在术中总出血量、建立隧道出血量、肌层切开出血量方面差异均无统计学意义(P＞0. 05),在术中及术后近期(1周)并发症发生率方面差异无统计学意义(P＝0. 76).在建立切口时间方面,铥激光组用时(3. 7±3. 0)min,高频电刀组用时(2. 3±1. 3)min,差异有统计学意义(P＝0. 02).术后1个月随访,铥激光组和高频电刀组的有效率分别为100. 0%(7/7)和87. 5%(7/8)(P＝0. 33),并发症发生率分别为14. 3%(1/7)和12. 5%(1/8)(P＝0. 92).术后3个月随访,铥激光组和高频电刀组的有效率分别为100. 0%(7/7)和75. 0%(6/8)(P＝0. 16),并发症发生率分别为28. 6%(2/7)和12. 5%(1/8) (P＝0. 60).结论 运用铥激光或高频电刀均能较好地完成 POEM 手术.相比高频电刀,运用1 940 nm铥激光行POEM治疗有降低手术时间、减少术中出血量的趋势,值得进一步研究.

abstractsObjective To evaluate the efficacy and safety of 1 940 nm thulium laser on peroral endoscopic myotomy (POEM) for treatment of patients with achalasia of cardia. Methods Fifteen patients undergoing POEM in Beijing Friendship Hospital from February 2016 to November 2016 were enrolled and divided into 1 940 nm thulium laser group ( n＝7) and high frequency electric knife group ( n＝8) using zelen′s design, with followed-up for three months. The operation time, success rate, efficacy, and complications were compared between the two groups. Results All the procedures were successfully completed. There was no significant difference on baseline between the two groups ( P＞0. 05). The time of total operation, creating submucosal tunnel, myotomy, and closing incision were not significantly different between the two groups (all P＞0. 05). The bleeding amount, creating tunnel bleeding amount, and myotomy bleeding amount were not significantly different between the two groups (all P＞0. 05). The complication rate during operation and one week after operation was not significantly different between the two groups ( P＝0. 76).The time of creating mucosal incision for the 1 940 nm thulium laser group was longer than that of the high frequency electric knife group ( 3. 7 ± 3. 0 min VS 2. 3 ± 1. 3 min, P＝ 0. 02). After one month of follow-up, the efficiency of the 1 940 nm thulium laser group and the high frequency electric knife group was 100. 0%(7/7) and 87. 5%(7/8), respectively (P＝0. 33), and the complication rate was 14. 3%(1/7) and 12. 5%(1/8), respectively (P＝0. 92). After three months of follow-up, the efficiency of the two groups was 100. 0%(7/7) and 75. 0%( 6/8), respectively ( P＝0. 16), and the complication rate was 28. 6%(2/7) and 12. 5%(1/8), respectively (P＝0. 60). Conclusion 1 940 nm thulium laser and high frequency electric knife both have good utility on POEM.1 940 nm thulium laser decreases the operating time and bleeding compared with high frequency electric knife.