内镜隧道手术治疗贲门失弛缓症及弥漫性食管痉挛患者的临床效果  

Clinical efficacy of tunnel endoscopic surgery for treatment of patients with achalasia cardia and diffuse esophageal spasm

作　　者：杜瑜[1] 杨瑞琦 黄华钦[1] 苏夏[1] 潘桂 DU Yu;YANG Rui-qi;HUANG Hua-qin;SU Xia;PAN Gui(Department of Gastroenterology,the Second People's Hospital of Qinzhou,Qinzhou 535000,China)

机构地区：[1]广西钦州市第二人民医院消化内科,钦州市535000

出　　处：《广西医学》2021年第23期2809-2813,2823,共6页Guangxi Medical Journal

基　　金：广西卫生健康委员会自筹经费科研课题(Z20200463)。

摘　　要：目的探讨内镜隧道手术(TES)治疗贲门失弛缓症及弥漫性食管痉挛患者的临床效果。方法将66例贲门失弛缓症或弥漫性食管痉挛患者随机分为观察组和对照组,每组33例。观察组患者采用TES行食管贲门括约肌切开术治疗,对照组患者采用胃镜下球囊扩张术治疗。记录两组患者手术时间、术后住院时间和住院费用;分别于术前、术后1个月、6个月、1年和2年,采用Eckardt评分评估患者的临床症状,并采用多层螺旋CT检测患者的食管最大直径、食管下括约肌(LES)静息压和LES松弛压;记录两组患者围术期的并发症发生情况。术后随访2年,比较两组患者手术成功率、复发情况和胃食管反流发生率。结果观察组患者的手术时间、术后住院时间和住院费用均长于或高于对照组(均P<0.05)。两组患者术后的Eckardt症状评分、食管最大直径、LES静息压和LES松弛压均呈先降低后升高的趋势,且在术后1个月、6个月、1年和2年,观察组的Eckardt评分、食管最大直径、LES静息压和LES松弛压均低于对照组(均P<0.05)。观察组患者术中皮下气肿的发生率高于对照组(P<0.05),而两组患者术中出血、气胸、气腹、术后感染发生率比较,差异均无统计学意义(均P>0.05)。术后2年,观察组患者手术成功率和胃食管反流发生率均高于对照组,术后复发率低于对照组(均P<0.05)。结论与球囊扩张术相比,TES治疗贲门失弛缓症、弥漫性食管痉挛可以更好地降低患者LES压力,缓解临床症状,提高手术成功率,降低术后复发率,但其住院费用较高,术后并发症相对较多。Objective To investigate the clinical efficacy of tunnel endoscopic surgery(TES) for the treatment of patients with achalasia cardia and diffuse esophageal spasm. Methods Sixty-six patients with achalasia cardia or diffuse esophageal spasm were randomly divided into observation group(n=33) and control group(n=33). Patients in the observation group were treated with esophagocardiac sphincterotomy using TES, and patients in the control group were treated with gastroscopic balloon dilatation. Patients′ operation duration, postoperative length of hospital stay and hospitalization costs were recorded in the two groups. Patients′ clinical symptoms were evaluated by the Eckardt score, and the maximum esophagus diameter, resting pressure of lower esophageal sphincter(LES), and LES relaxation pressure were measured by multi-slice spiral CT before the operation, one month, six months, one year, and two years after the operation, respectively;the incidence of patients′ perioperative complications was recorded in the two groups. The patients were followed up for two years after the operation, and the success rate of operation, the condition of recurrence, and the incidence rate of gastroesophageal reflux were compared between the two groups.Results The observation group reported a longer operation duration, a longer length of postoperative hospital stay, and higher hospitalization costs than the control group(all P<0.05). The Eckardt symptom score, maximum esophagus diameter, LES resting pressure, and LES relaxation pressure after the operation exhibited a tendency to decline first and then rise in both groups;moreover, one month, six months, one year, and two years after the operation, the observation group yielded lower Eckardt symptom score, maximum esophageal diameter, LES resting pressure, and LES relaxation pressure as compared with the control group(all P<0.05). The incidence rate of intraoperative subcutaneous emphysema in the observation group was higher than that in the control group(P<0.05), whereas there wa

关 键 词：贲门失弛缓症 弥漫性食管痉挛 内镜隧道手术 球囊扩张术 食管下括约肌 Eckardt评分 疗效 住院费用 并发症 预后 

分 类 号：R656.6[医药卫生—外科学]