内镜下支架置入治疗贲门失迟缓症27例  被引量:9

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

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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]

 

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