继发性贲门失弛缓症(5例报告并文献复习)  

Report of five cases with secondary achalasia and review of literature

作　　者：胡健[1] 常栋[1] 龚民[1] 

机构地区：[1]首都医科大学附属北京友谊医院胸外科,100050

出　　处：《北京医学》2016年第1期20-23,共4页Beijing Medical Journal

摘　　要：目的总结继发性贲门失弛缓症临床特征及误诊原因。方法经计算机选取2000-2012年本院确诊的贲门失弛缓症患者149例,其中5例为继发性贲门失弛缓症,观察症状持续时间;钡餐下食管形态学改变,包括食管最大宽度及狭窄长度变化;胃镜下贲门黏膜改变;食管下段压力变化,CT检查结果。结果本组继发性贲门失驰缓症平均年龄(54.0±23.7)岁,症状持续时间平均(4.6±0.7)个月,检查显示食管贲门狭窄长度平均(3.80±0.26)cm,食管最大径平均(4.32±0.64)cm,食管下端括约肌测压(LES)检查平均(40.50±0.70)cm H_2O,CT检查提示食管下段贲门及纵隔占位,手术探查病理证实胃黏液腺癌1例,贲门腺癌2例,食管下段鳞状细胞癌1例,纵隔型肺腺癌1例。结论继发性贲门失弛缓症少见,临床诊断中多存在误诊,延误治疗,应根据患者资料全面认真分析,做出正确判断。Objective Our purpose is to analyse the clinical parameters and causes of misdiagnosis of secondary achalasia. Methods 149 patients with a diagnosis of achalasia were identified in computerized medical charts of our hospital from 2000 through 2012. Among them, 5 patients were secondary achalasia. Medical records were reviewed to determine the clinical presentations, the morphologic features of the narrowed distal esophageal segment and gastric cardia and mediastina by barium studies,endoscopic, manometric and CT scan findings. Results The mean patient age was（54.0±23.7）years. The mean duration of dysphagia was（4.6±0.7）months, The narrowed distal esophageal segment had a mean length of（3.80 ± 0.26）cm, and the esophagus had a mean diameter of（4.32 ± 0.64）cm in secondary achalasia. LES was（40.50±0.70）cm H_2O. CT scans revealed a mass near the distal esophagus and caidia.Histopathology revealed gastric carcinoma in one case, cardia adenocarcinoma in two cases, esophageal squamous cell carcinoma in one case, and lung adenocarcinoma in one. Conclusion Secondary achalasia is rare, and is easily to be misdiagnosis. When findings of achalasia on barium studies with recent onset of dysphagia are present, secondary achalasia should be considered.

关 键 词：贲门失弛缓症 继发性贲门失弛缓症 食管胃连接部 吞咽困难 

分 类 号：R571[医药卫生—消化系统]