内镜下支架置入治疗贲门失迟缓症27例  

Endoscopic retrievable stent placement for treatment of esophageal achalasia:an analysis of 27 cases

作　　者：秦咏梅[1] 张彩风[1] 刘竹娥[1] 罗艳丽[1] 王文菊[1] 

机构地区：[1]新乡医学院第一附属医院消化内科,河南省卫辉市453100

出　　处：《世界华人消化杂志》2010年第19期2043-2046,共4页World Chinese Journal of Digestology

摘　　要：目的:观察胃镜下支架置入治疗贲门失弛缓症的近期、远期疗效和安全性.方法:对我院2003-2007年就诊的27例贲门失迟缓症患者,经临床、钡餐造影、内镜检查确诊,随机分组进行胃镜下支架置入或球囊扩张治疗.记录扩张前和扩张后1mo的症状积分、食管下段括约肌压力(lower esophageal sphincter,LESP)、钡餐造影显示的食管最大宽度及食管体部蠕动情况,并进行2年随访.结果:2组患者扩张后1mo复查吞咽困难等症状均明显缓解.支架组、球囊组有效率分别为83.3%(10/12)、85.7%(12/14),症状积分治疗前、后为6.4分±1.6分、6.1分±1.6分和3.2分±1.9分、3.5分±1.7分;LESP治疗前、后为25.2mmHg±2.5mmHg、26.3mmHg±2.2mmHg和20.9mmHg±1.9mmHg、21.6mmHg±1.7mmHg;食管的最大宽度治疗前、后为6.2cm±1.3cm、5.5cm±1.5cm和4.2cm±1.3cm、3.6cm±1.3cm,2组治疗前后数据差异有统计学意义(均P<0.01),治疗有效,但组间相比无差异(P>0.05).随访6mo、1年、2年,支架组症状缓解率分别为75.0%(9/12)、66.7%(8/12)、58.3%(7/12);球囊组为64.3%(9/14)、50.0%(7/14)、42.9%(6/14).2年有效率两组有差异(P<0.01).球囊组1例患者出现纵膈穿孔,手术治愈,退出观察,余患者均未出现严重并发症.结论:内镜下支架置入、球囊扩张治疗贲门失弛缓症近期、远期疗效较好,并发症少,可降低LESP,减少食管扩张程度,从而缓解症状,支架置入远期疗效更佳.AIM：To compare the efficacy and safety of endoscopic retrievable stent placement and pneumatic dilation in the treatment of achalasia.METHODS：A total of 27 patients diagnosed with achalasia were allocated for a temporary retrievable stent placement （n=12,therapeutic group） or pneumatic dilation （n=15,control group）.The stents were placed using a gastroscope under fluoroscopic guidance,and removed 10-14 d after placement.Data on the symptom scores,the diameter of lower esophagus,the lower esophageal sphincter pressure,the response rate,and the rate of complications were compared between the two groups.Follow-up observations were performed at 1 month and at 1 and 2 years postoperatively.RESULTS：Stent placement and pneumatic dilation were technically successful in 26 patients.Only one patient in the control group developed mediastina fistula and exited.Statistically significant differences were noted between pretreatment and post-treatment data on the symptom scores,the diameter of lower esophagus,and the lower esophageal sphincter pressure （all P〈 0.01）.There were no significant differences in therapeutic outcomes at 1 mo between the two groups.The response rates in the therapeutic group at 1 mo,6 mo,1 year and 2 years were 83.3%,75.0%,66.7% and 58.3%,respectively,and those in the control group were 85.7%,64.3%,50.0% and 42.9%,respectively.There were significant differences in the remission rates at 1 and 2 years between the two groups （both P〈 0.01）.CONCLUSION：Both endoscopic retrievable stent placement and pneumatic dilation are effective and safe in the treatment of achalasia.Temporary retrievable stent placement is associated with a better long-term clinical efficacy as compared with pneumatic dilation.

关 键 词：贲门失弛缓症 球囊扩张 内镜检查 支架 

分 类 号：R571[医药卫生—消化系统]