贲门失弛缓症内镜下治疗的临床观察  

Clinical observation of treatment of achalasia by endocopy

作　　者：苏海燕[1] 刘文天[1] 王邦茂[1] 杨玉龙[1] 吕宗舜[1] 姜葵[1] 张洁[1] 方维丽[1] 

机构地区：[1]天津医科大学总医院消化科,天津300052

出　　处：《中国内镜杂志》2004年第8期5-7,共3页China Journal of Endoscopy

摘　　要：目的贲门失弛缓症有药物、手术和内镜下治疗,各自优势如何,仍需进一步探讨。方法38例患者,肉毒毒素注射13例,球囊扩张20例,外科手术(食管下括约肌成形术)5例,比较治疗前及治疗后1,6,12和24个月食管梗阻程度和发生频率,评估疗效和不良反应。结果3种治疗均有效,治疗后1个月的缓解率显著高于治疗前。治疗后12个月,球囊扩张和手术仍有较高的缓解率,明显高于肉毒毒素注射治疗。治疗后24个月,球囊扩张术和手术治疗的许多患者症状再加重。球囊扩张术不良反应的发生率较多。结论3种治疗均是有效的方法。球囊扩张术和手术的疗效持续时间相似,均比肉毒毒素注射长,但后者具有痛苦小,安全的优点。Objective:Achalasia is an esophageal motor disorder characterized by aperistalsis and incom-plete relaxation of the lower esophageal sphincter(LES).The methods of treating Achalasia included drug,surgery(formation of lower esophagus sphincter)and endoscopy,but the curative effect of them would be re-quired to investigate.Methods:38patients with achalasia were investigated,including13patients treated by botulinum toxin,20patients treated by balloon dilation,5patients treated by surgery.The degree of severity and frequency of esophagus obstruction(dysphagia,chest pain,reflux)and adverse effect as investigated before treatment and1,6,12and24months after treatment.Results:The higher curative effect as gotten by bo-tulinum toxin,balloon dilation and surgery.It was found that rate of relief in1month after treatment in pa-tients treated by botulinum toxin was100%in degree and92.3%in frequency;90%in degree and90%in frequency in patients treated by balloon dilation;80%in degree and100%in frequency in patients treated by surgery.12months later,the rates of relief in patients treated by surgery(80%and100%)and balloon di-lation(80%and90%)were significantly higher than patients treated by botulinum toxin(20%and40%).24months later,many patients treated by surgery and balloon dilation relapsed in degree.Rates of adverse effect in patients treated by surgery and balloon dilation were more than patients treated by botulinum toxin.Con-clusion:Botulinum toxin and balloon dilation are the effective methods of treating than that of botulinum tox-in,but the advantages of botulinum toxin are gently pain and safe.

关 键 词：贲门失弛缓症 肉毒毒素 食管扩张 

分 类 号：R573.7[医药卫生—消化系统]