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首页> 外文期刊>Surgical Endoscopy >Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis
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Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis

机译：腹腔镜幽门成形术与内窥镜每口腔幽门组织术治疗胃流血

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BackgroundGastroparesis is a debilitating functional disorder of the stomach characterized by delayed gastric emptying absent an obstructive etiology. Surgical or endoscopic disruption of the pylorus has been utilized to treat this disease, but there is little evidence comparing laparoscopic pyloroplasty (LP) with endoscopic per-oral pyloromyotomy (POP). Herein we describe our experience at our institution using a propensity-matched cohort study to compare outcomes between these procedures.MethodsAll patients who underwent LP for the treatment of gastroparesis from October 2014 through September 2017at our institution were retrospectively reviewed. Propensity scoring was used to match these patients 1:1 to patients undergoing POP during this time period based on gender, age, and etiology of gastroparesis. Symptom scores using the Gastroparesis Cardinal Symptom Index (GCSI), scintigraphic gastric emptying studies (GES), and perioperative outcomes were compared between matched cohorts. Thirty patients underwent LP for gastroparesis during the study period which were matched 1:1 with patients undergoing POP. The etiology of gastroparesis was 63.3% idiopathic (n=19), 20.0% post-surgical (n=6), and 16.7% diabetic (n=5) in both cohorts.ResultsPatients who underwent LP had a longer average length of stay (4.6 vs. 1.4 days, p=0.003), operative time (99.3 vs. 33.9min, p<0.001), and estimated blood loss (12.9 vs. 0.4mL, p<0.001). There were more complications in the LP cohort (16.7 vs. 3.3%, p=0.086), which included surgical site infection (6.7 vs. 0%, p=0.153), pneumonia (6.7 vs. 0.0%, p=0.153), and unplanned ICU admission (10.0 vs. 0.0%, p=0.078). LP and POP both resulted in similar, significant improvements in both in GCSI scores and objective gastric emptying.ConclusionsPer-oral endoscopic pyloromyotomy (POP) is safe and effective for the treatment of medical refractory gastroparesis. POP has less perioperative morbidity compared to LP with comparative functional outcomes.
机译：背景皮那resis是一种衰弱的胃功能障碍，其特征在于延迟胃排空，缺乏阻塞病因。幽门的外科或内窥镜破坏已被利用来治疗这种疾病，但几乎没有证据表明腹腔镜幽门成形术（LP）与内窥镜每口腔幽门瘤细胞术（POP）进行比较。在此，我们使用倾向匹配的群组研究描述了我们在我们的机构的经验，以比较这些程序之间的结果。关于从2014年10月到2017年9月到2017年9月，我们的机构接受了LP的胃动脉术患者的患者是回顾性审查的。倾向评分用于将这些患者1：1与胃流血的性别，年龄和病因在此时间段进行患者的患者。在匹配的队列之间比较症状分数使用胃术着基本症状指数（GCSI），闪烁的胃排空研究（GES）和围手术期结果。在研究期间，患者患者患有胃病患者的30名患者，患者与接受POP的患者匹配。胃流离失核性的病因为63.3％特发性（n = 19），20.0％后手术后（n = 6），伴有16.7％的糖尿病（n = 5），均为LP的平均逗留时间较长（ 4.6与1.4天，p = 0.003），操作时间（99.3 vs.33.9min，p <0.001）和估计失血（12.9 vs.0.4ml，p <0.001）。 LP队列（16.7与3.3％，P = 0.086）中存在更多的并发症，包括外科部位感染（6.7对0％，P = 0.153），肺炎（6.7与0.0％，P = 0.153），和无计划的ICU入院（10.0与0.0％，P = 0.078）。 LP和POP都导致GCSI评分和客观胃排空中的相似性，显着改善。结合 - 口腔内窥镜幽门瘤细胞术（POP）对医疗难治性胃术治疗安全有效。与具有比较功能结果的LP相比，POP具有较少的围路发病率。

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