经口内镜下肌切开术治疗贲门失弛缓症的疗效分析  

Analysis on therapeutic effects of peroral endoscopic myotomy in esophageal achalasia

作　　者：郁心圃[1] 刘鹏飞[1] 包静龙[1] 

机构地区：[1]东南大学医学院附属江阴医院消化科,江苏江阴214400

出　　处：《实用临床医药杂志》2013年第17期48-50,共3页Journal of Clinical Medicine in Practice

基　　金：中国高校医学期刊临床专项资金(11321190)

摘　　要：目的探讨经口内镜下肌切开术治疗贲门失弛缓症的临床疗效及安全性。方法回顾性分析本院2011年1月-2012年5月本院收治的13例贲门失弛缓症患者的临床资料,均采用经口内镜下肌切开术治疗。分析手术完成情况、食管动力学指标变化、并发症及随访情况。结果手术成功率为100%,术后第4天所有患者均顺利进行流质饮食,吞咽困难较术前明显缓解。术后第3天患者食管下端括约肌静息压及4 s完全松弛压均较术前显著降低。术中及术后均未发现气胸、发热、严重出血等患者。所有患者均获得12个月的随访,吞咽困难、呕吐及胸骨后疼痛症状消失。复查胃镜显示食管创面愈合良好,贲门口明显扩大;消化道碘油造影显示食管腔较术前显著缩小。结论经口内镜下肌切开术可在短期内有效降低贲门失弛缓症患者食管下端括约肌静息压及括约肌4 s完全松弛压,缓解吞咽困难、胸骨后疼痛等症状,且并发症发生率低,安全而有效。Objective To explore the clinical effect and safety of peroral endoscopic myoto- my in esophageal achalasia. Methods The clinical data of 13 patients with esophageal achalasia from January 2011 to May 2012 in our hospital were retrospectively analyzed. All of the patients received peroral endoscopic myotomy. The operation completion, changes of esophageal dynamics indexes, complications and follow- up condition were analyzed. Results The success rate of surgery came up to 100 %, and all of the patients received liquid diet, and the dysphagia eased significantly on day 4 after operation. Lower esophageal sphincter resting pressure and 4s complete relaxation pressure on day 3 after operation, were significantly lower than that before operation. There was no patient with pneumothorax, fever, severe bleeding before and during the operation. All of the patients re- ceived 12 month- follow- up, the dysphagia, retrosternal pain, vomiting and symptom disap- peared. Gastroscope examination showed that the wound healed well, ostiumcardiacum significantly expanded. Digestive tract iodine oil radiography showed that the esophageal lumen significantly nar- rowed than before operation. Conclusion Peroral endoscopic myotomy can effectively reduce the lower esophageal sphincter resting pressure and 4s complete relaxation pressure of patients with esophageal achalasia, alleviate dysphagia and retrosternal pain, and lower complication incidence, with more safety and effectiveness.

关 键 词：贲门失弛缓症 经口内镜下肌切开术 食管压力检测 食管动力 

分 类 号：R573.7[医药卫生—消化系统]