grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-46252686-7370Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2020-179-3-62-68grekov-1492Research ArticleЭНДОСКОПИЯ И ВНУТРИПРОСВЕТНАЯ ХИРУРГИЯENDOSCOPY AND ENDOLUMINAL SURGERYФиброзные изменения подслизистого слоя у больных ахалазией кардииSubmucosal fibrotic changes in patients with esophageal achalasiahttps://orcid.org/0000-0002-6440-2370СмирновА. А.SmirnovA. A.

Смирнов Александр Александрович, кандидат медицинских наук, доцент кафедры госпитальной хирургии № 2, руководитель отдела эндоскопии НИИ хирургии и неотложной медицины

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8.

Smirnov Alexander A., Cand. of Sci. (Med.), associate Professor of the Department of Hospital Surgery No. 2, Head of the Endoscopy Department of the Research Institute of Surgery and Emergency Medicine

6-8, L. Tolstoy str., Saint Petersburg, 197022, Russia.

smirnov-1959@yandex.ruhttps://orcid.org/0000-0003-1110-1379ЛюбченкоМ. Е.LyubchenkoM. E.

Любченко Мария Евгеньевна, врач-эндоскопист

Санкт-Петербург

Lyubchenko Mariya E., endoscopist

Saint Petersburg

https://orcid.org/0000-0003-3821-3805КирильцеваМ. М.KiriltsevaM. M.

Кирильцева Майя Михайловна, врач-эндоскопист

Санкт-Петербург

Kiriltseva Maya M., endoscopist

Saint Petersburg

https://orcid.org/0000-0001-6623-5601КонкинаН. В.KonkinaN. V.

Конкина Надежда Владиславовна,  врач-эндоскопист

Санкт-Петербург

Konkina Nadezhda V., endoscopist

Saint Petersburg

https://orcid.org/0000-0003-4504-4077КорчакМ. В.KorchakM. V.

Корчак Марина Васильевна, клинический ординатор 2-го года обучения кафедры госпитальной хирургии № 2

Санкт-Петербург

Korchak Marina V., 2-year Clinical Resident of the Department of Hospital Surgery No. 2

Saint Petersburg

https://orcid.org/0000-0002-0920-7329КрасковА. В.KraskovA. V.

Красков Антон Викторович, клинический ординатор 2-го года обучения

Санкт-Петербург

Kraskov Anton V., 2-year Clinical Resident

Saint Petersburg

https://orcid.org/0000-0002-2020-0371МерзляковВ. М.MerzlyakovV. M.

Мерзляков Василий Михайлович, студент VI курса

Санкт-Петербург

Merzlyakov Vasiliy M., 6-year student

Saint Petersburg

https://orcid.org/0000-0002-2020-0371ЯицкийН. А.YaitskyN. A.

Яицкий Николай Антонович, доктор медицинских наук, профессор, академик РАН, зав. кафедрой хирургии госпитальной с клиникой

Санкт-Петербург

Yaitsky Nikolai A., Dr. of Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Head of the Department of Hospital Surgery with Clinic

Saint Petersburg

https://orcid.org/0000-0002-6380-137XБагненкоС. Ф.BagnenkoS. F.

Багненко Сергей Фёдорович, доктор медицинских наук, профессор, академик РАН, ректор

Санкт-Петербург

Bagnenko Sergey F., Dr. of Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Rector

Saint Petersburg

Федеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияPavlov UniversityRussian Federation20201405202017936268Copyright © Смирнов А.А., Любченко М.Е., Кирильцева М.М., Конкина Н.В., Корчак М.В., Красков А.В., Мерзляков В.М., Яицкий Н.А., Багненко С.Ф., 20202020Смирнов А.А., Любченко М.Е., Кирильцева М.М., Конкина Н.В., Корчак М.В., Красков А.В., Мерзляков В.М., Яицкий Н.А., Багненко С.Ф.Smirnov A.A., Lyubchenko M.E., Kiriltseva M.M., Konkina N.V., Korchak M.V., Kraskov A.V., Merzlyakov V.M., Yaitsky N.A., Bagnenko S.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/1492ЦЕЛЬ

ЦЕЛЬ. Оценить выраженность фиброза подслизистого слоя у больных ахалазией пищевода, а также оценить его влияние на выполнение и непосредственные результаты эндоскопической пероральной миотомии.

МЕТОДЫ И МАТЕРИАЛЫ

МЕТОДЫ И МАТЕРИАЛЫ. В исследование вошли 116 больных ахалазией пищевода, которым была выполнена пероральная эндоскопическая миотомия в клинике ПСПбГМУ им. И. П. Павлова с июня 2015 г. по март 2019 г. Средний возраст пациентов составил 50 лет. Из них мужчин было 42, женщин – 74. По данным видеозаписей проведен ретроспективный анализ 116 пероральных эндоскопических миотомий, выполненных в условиях ПСПбГМУ им. И. П. Павлова больным ахалазией кардии.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Среднее время операции составило 89,6 мин. Во время операции у всех больных фиксировали изменения слизистой оболочки пищевода, которые оценивали по классификации EMIA, а также во время формирования тоннеля оценивали выраженность фиброза подслизистого слоя по 3-степенной классификации (SMF от 0 до 3 степени). Было обнаружено, что SMF1 имел место у 20 больных, SMF2 – у 44 больных, а SMF3 – у 48 больных; выделена новая группа тяжелого фиброза подслизистого слоя – 3b, сопровождавшаяся в нашем исследовании наибольшей, 25 %-й, частотой перфорации слизистой оболочки во время операции.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Интраоперационными находками у подавляющего большинства больных явился фиброз подслизистого слоя различной степени выраженности, влияющий на время выполнения пероральной эндоскопической миотомии и осложнения.

The OBJECTIVE of the study was to evaluate the severity of submucosal fibrosis in patients with esophageal achalasia, its influence on technical and clinical success of peroral endoscopic myotomies (POEM), and their results.

METHODS AND MATERIALS

METHODS AND MATERIALS. The study included 116 patients with esophageal achalasia who underwent POEM in the Clinic of the Pavlov First Saint Petersburg State Medical University from June 2015 to March 2019. The mean age of patients was 50 years. It included 42 men and 74 women. This research was based on the retrospective analysis of video recordings of 116 POEM that were performed on patients with esophageal achalasia at the Endoscopy Department at the Pavlov First Saint Petersburg State Medical University.

RESULTS

RESULTS. The mean operation time was 89.6 minutes. During the operation, changes in the esophageal mucosa were recorded in all patients, which were classified according to the esophageal mucosa in achalasia (EMIA), and during creating the tunnel, the severity of submucosal fibrosis (SMF) was evaluated according to the three-stage classification (SMF from 0 to 3 stage). We found out that SMF-1 occurred in 20 patients, SMF-2 occurred in 44 patients and SMF-3 occurred in 48 patients; we identified a new group of severe submucosal fibrosis – 3b that accompanied in our study by the highest 25 % frequency of mucosal perforation during surgery.

CONCLUSION

CONCLUSION. The submucosal fibrosis of various SMF grades was determined intraoperatively in the majority of the patients and affected the POEM duration and complications.

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The authors declare that there are no conflicts of interest present.