吴婕 1李萍 1仇晓霞 1周平红 2黄志恒 1黄瑛1
作者信息
- 1. 复旦大学附属儿科医院消化内镜中心 上海,201102
- 2. 复旦大学附属中山医院内镜中心 上海,200032
- 折叠
摘要
Abstract
Background Peroral endoscopic myotomy(POEM)is a minimally invasive technique for treating pediatric acha-lasia(AC).Perioperative nursing management is crucial for procedural success and patient recovery.However,related research re-mains limited.Objective To explore the clinical characteristics of children with AC undergoing POEM and summarize the periop-erative nursing coordination strategies.Design Case series report.Methods Clinical data of children diagnosed with AC and treated with POEM at the Children's Hospital of Fudan University(January 1,2014-May 1,2024)wereretrospectively analyzed.The perioperative nursing coordination protocols for POEM were systematically summarized.Main Outcome Measures POEM duration and complication rates.Results A total of 51 children(29 males,22 females)who underwent POEM for AC were includ-edMedian operative age was 8.1 years(3.1,11.5),the median disease duration was 12.0 months(6.0,24.0),and the median op-erative time was 28.0 minutes(25.0,30.0).The preoperative Eckardt score was 4.0 points(2.0,4.0),while the Eckardt score at the last follow-up(37 cases)was 0 points(0,1.0),showing a statistically significant difference(P<0.001).The main presenting symptoms were vomiting(38 cases,73.1％)and dysphagia(26 cases,50％).At the last follow-up,35 cases achieved complete resolution of vomiting/chest pain,with 31 cases showing dysphagia remission..Upper gastrointestinal barium meal examination was performed in 23 cases at 1 month postoperatively,revealing patent esophagus in 20 cases and mild narrowing or stenosis in different esophageal segments in 3 cases.Gastroscopy was performed in 36 cases at 6 months postoperatively,showing patent esophagus or cardia in 15 cases,granulation tissue or mucosal hyperplasia in 13 cases,and esophagitis in 10 cases.Complications occurred in 11 cases(21.6％),including 1 case of intraoperative pneumothorax with SpO2 decline.Postoperative complications included pneu-moperitoneum(6 cases)and subcutaneous emphysema(4 cases).There were no perioperative deaths.Two cases underwent reop-eration due to unsatisfactory surgical outcomes.At the last follow-up,the mean follow-up duration for 37 cases was(5.9±3.2)years,with 1 death due to sepsis 2 years postoperatively.Conclusion POEM demonstrates efficacy for pediatric AC.A high-qual-ity perioperative nursing coordination protocol facilitates smooth surgical execution,reduces operative time,and minimizes postop-erative complications.关键词
贲门失弛缓症/经口内镜下肌切开术/护理配合/儿童Key words
Achalasia/Peroral endoscopic myotomy(POEM)/Nursing coordination/Children
