贲门失弛缓症患者术后远期食管功能分析  

Long-term results of esophageal motor dysmotility after Heller＇s myotmy for achalasia

作　　者：于磊[1] 李建业[1] 王天佑[2] 丁燕[1] 张云峰[1] 藏楠[1] 

机构地区：[1]首都医科大学附属北京同仁医院胸外科,100730 [2]首都医科大学附属北京友谊医院胸外科

出　　处：《中华医学杂志》2010年第1期53-55,共3页National Medical Journal of China

摘　　要：目的探讨贲门失弛缓症患者改良Heller术后远期食管运动功能变化的特点。方法1998年至2004年，首都医科大学附属北京同仁医院胸外科随访经腹改良Heller术治疗贲门失弛缓症患者72例，随访期3—10年。对其症状、食管动力学和食管腔内24h的pH值等进行记录。结果食管下括约肌切开侧压力由术前（44±12）mmHg降至（10±5）mmHg，松弛率由49％±20％升至84％±15％，差异有统计学意义（P〈0．05）。有进食梗阻感的24例患者中，11例食管下括约肌两个方向压力高于正常，松弛功能不良；7例3个方向压力高于正常，松弛功能不良。全组患者吞咽后体部全部表现为同步收缩及无传导收缩，缺乏推进性蠕动。结论成功的改良Heller术后远期食管动力学功能特点为：①食管下括约肌的静息压力至少一个方向压力低于正常，至少一个方向压力高于正常。②食管下括约肌在吞咽时食管后壁仍弛缓障碍，不能充分松弛。术后进食有梗阻感者，表现为2～3个方向松弛不良。③吞咽时食管体均为同步收缩波，无正常的蠕动波可见，食物靠重力作用通过食管。Objective To investigate the long-term characteristics of both clinical manifestation and esophageal motor disturbance in achalasia patients after Heller＇s myotmy. Methods After 3 to 10 years＇ follow-up, clinical manifestation, esophageal motor function and 24-hour continuous esophageal pH monitoring in 72 post-operative cases of achalasia were recorded. Results The mean LES pressure decreased from 44 ± 12 mm Hg to 10 ±5 mm Hg , and the rate of L ES relaxation rised from 49% ±20% to 84% ± 15% （paired t test, P〈0. 05）. Of 24 cases with choking feeling, 11 had the high LES pressure and dysfunction in two directions and 7 in three. During swallowing, incomplete lower esophageal sphincter relaxation and aperistalsis were detected in all patients. Conclusions The long-term characteristics of esophageal function following successfully surgical treatment to patients with Achalasia are： （1）After Heller＇s myotmy, LESP in at least one direction is lower than the normal standard, while higher in at least one direction. （2）During swallowing, the esophageal rear wall is lack of complete LES relaxation. For patients with choking feeling, complete LES relaxation occurs in 2-3 directions. （3）Due to lack of esophageal peristalsis, food goes through esophagus by gravitation.

关 键 词：食管失弛症 手术 治疗结果 

分 类 号：R571[医药卫生—消化系统]