核素显像对贲门失弛症手术疗效的评价

Estimation of surgical results of achalasia by gastro-esophageal scintiscan

作者对３６例贲门失弛症术后患者行核素显像检查，以观察食管排空能力和胃食管反流情况，其中单纯Ｈｅｌｌｅｒ手术者２０例，Ｈｅｌｌｅｒ手术加抗反流手术者１６例。方法是：受检者口服含５ｍＣｉ￣（９９ｍ）Ｔｃ－ＤＴＰＡ酸化桔汁１０ｍｌ，用ＥＣＴ测定食管清除率，然后再口服酸化桔汁３００ｍｌ，在腹部加压的条件下测定胃食管反流情况。结果表明单纯Ｈｅｌｌｅｒ手术组第１和第２分钟食管清除率明显高于抗反流手术组（Ｐ＜０．０５），而胃食管反流的发生率两组无差别（Ｐ＞０．０５）。作者认为Ｈｅｌｌｅｒ手术加抗反流手术只能增加食管排空阻力，却无明显抗反流作用。因此，Ｈｅｌｌｅｒ手术不应附加任何抗反流手术。

AbstractThirty-six patients with achalasia were examinedby gastroesophageal scintiscan after esophagomyotomy(Heller's myotomy)in order to survey esophagealemptying ability and gastroesophageal reflux. Sixteenof the 36 patients had additional antireflux procedures.After oral intake of orange juice containing 5mCi￣(99m)Tc-DTPA, the patients were examined for esophagealamptying ability by ECT. Gastroesophageal reflux wasobserved under variant intraabdominal pressure. Insole Heller's myotomy group,esophageal emptyingrates at 1 and 2 minutes were better than those ofHeller plus antireflux group (P < 0.05 ).However,there was no significant difference in occurrence of gas-troesophageal reflux between the two groups(P>0.05).In this series, Heller's myotomy plus antirefluxprocedures obstructed esophageal emptying rather thanhindered gastroesophageal reflux, so that any antire-flux procedure should not be undertaken after Heller'smyotomy.