A subscription to JoVE is required to view this content.
You will only be able to see the first 2 minutes.
The JoVE video player is compatible with HTML5 and Adobe Flash. Older browsers that do not support HTML5 and the H.264 video codec will still use a Flash-based video player. We recommend downloading the newest version of Flash here, but we support all versions 10 and above.
If that doesn't help, please let us know.
在经口内窥镜肌切开术中使用剪刀治疗贲门失弛缓症
Chapters
Summary March 3rd, 2023
Please note that all translations are automatically generated.
Click here for the English version.
为了尽量减少技术难度并提高经口内窥镜肌切开术（POEM）的安全性，我们描述了一种使用剪刀式刀进行POEM主要步骤的方案，包括粘膜切口，粘膜下隧道，肌切开术和止血。
Transcript
经口内窥镜肌切开术已获得全球认可，是与充气扩张和海勒肌切开术并列的首批九种治疗方式之一 对于贲门失弛缓症患者 在POEM手术过程中，内窥镜针刀最常用于粘膜下隧道和肌切开术，结合止血钳来管理大血管和活动性出血。由于贲门失弛缓症患者食管胃交界处松弛势在必行，EGJ水平的有限空间增加了使用针型刀进行组织平面解剖和选择性肌切开术的技术难度 此外，仍在经历学习曲线短语的操作人员可能不太熟练，以换取止血钳控制出血 为了最大限度地降低POEM的技术难度，提高POEM的安全性， 在本视频中，我们描述了使用癫痫发作型刀进行POEM手术主要步骤的方案，包括粘膜切口粘膜下隧道，肌切开术和止血术。通过紧密的外观识别EGJ。
通过EGJ操纵内窥镜时确认阻力增加 通过测量与门牙的距离来注意EGJ的位置。选择食管后壁 EGJ 近端 7 至 9 厘米的摄入点。用内窥镜摄入针将含有亚甲蓝的生理盐水注射到粘膜下间隙。
用剪刀式刀做一个1.5到2厘米的纵向粘膜切口。平行于母层旋转剪刀式刀的刀片。然后，在粘膜下组织这一侧形成一个朝向EGJ下方两到三厘米的粘膜下隧道。
保持解剖平面靠近肌肉层 将含有亚甲蓝的生理盐水注入粘膜下组织。通过隧道进展扩大工作空间 通过丰富地方视图上的胃粘膜下层的蓝色变色确认足够的粘膜下层隧道透镜。使用剪刀式刀进行术间血管顶部和出血控制，而无需动用止血钳。
在粘膜入口远端约两厘米处开始肌切开术，选择性优雅和下降。内部圆形肌肉束与剪刀式刀。标准肌切开术 2 到 3 厘米到胃有氧运动 完成肌切开术通过 EGJ 确认最多的乘客通过重新插入。
内窥镜进入 用室内夹子关闭粘膜入口 与针型刀相比。剪刀式刀在抓住目标组织后可实现凝血和解剖。同时，剪刀式刀具有增强的止血能力。
类似于止血钳，两个叶片外部的绝缘涂层。三名贲门失弛缓症患者使用剪刀式刀接受了POEM。在我们的机构中，一名患者存在乙状结肠食管。
一名患者既往接受过充气扩张。所有患者均取得了技术上的成功，没有出现术前不良证据。在这个POEM手术中，所有出血控制和血管上限都由剪刀管理，不使用止血钳。
手术时间分别为60 45和40分钟。在三个月的随访中，所有患者都取得了临床成功，术后记录的分数从0到1不等。术后高分辨率测压和埋葬食管数据显示，食管下括约肌压力4秒综合松弛、压力和食管直径显著降低。
一名患者的内镜检查发现低度食管炎，无反射症状。使用剪刀式刀可以最大限度地降低技术难度，提高POEM程序的安全性，可能适合学员在学习曲线短语。未来纳入的大型随机对照试验证实了与传统刀具相比，使用剪刀进行POEM的安全性、有效性和学习曲线。
Related Videos
You might already have access to this content!
Please enter your Institution or Company email below to check.
has access to
Please create a free JoVE account to get access
Login to access JoVE
Please login to your JoVE account to get access
We use/store this info to ensure you have proper access and that your account is secure. We may use this info to send you notifications about your account, your institutional access, and/or other related products. To learn more about our GDPR policies click here.
If you want more info regarding data storage, please contact gdpr@jove.com.
Please enter your email address so we may send you a link to reset your password.
We use/store this info to ensure you have proper access and that your account is secure. We may use this info to send you notifications about your account, your institutional access, and/or other related products. To learn more about our GDPR policies click here.
If you want more info regarding data storage, please contact gdpr@jove.com.
Your JoVE Unlimited Free Trial
Fill the form to request your free trial.
We use/store this info to ensure you have proper access and that your account is secure. We may use this info to send you notifications about your account, your institutional access, and/or other related products. To learn more about our GDPR policies click here.
If you want more info regarding data storage, please contact gdpr@jove.com.
Thank You!
A JoVE representative will be in touch with you shortly.
Thank You!
You have already requested a trial and a JoVE representative will be in touch with you shortly. If you need immediate assistance, please email us at subscriptions@jove.com.
Thank You!
Please enjoy a free 2-hour trial. In order to begin, please login.
Thank You!
You have unlocked a 2-hour free trial now. All JoVE videos and articles can be accessed for free.
To get started, a verification email has been sent to email@institution.com. Please follow the link in the email to activate your free trial account. If you do not see the message in your inbox, please check your "Spam" folder.
