摘要
目的探讨贲门失弛缓症患者小气囊扩张联合肉毒碱局部注射治疗对食管动力学的影响及临床效果。方法经X线钡剂造影、内镜检查、食管动力学检查确诊的贲门失弛缓症患者38例,在内镜或X线监视下,用OTW气囊扩张,压力为2.5kPa,持续10￣30s,重复2、3次,肉毒毒素于下食管括约肌内局部注射。在治疗前后分别采用瑞典CTDPCPolyraf液压毛细灌注系统对38例患者作下食管括约肌压力(LESP)与松弛率(LESRR)以及食管内24hpH检测。结果治疗前LESP为(7.58±1.43)kPa,松弛率为(30.75±3.36)%;治疗后LESP为(3.12±1.57)kPa,松弛率为(60.87±3.48)%,差异均有显著性(P<0.01)。治疗前后食管24hpH检测显示无异常反流,临床表现明显改善,可进半流质及普食。38例均未发生任何并发症。结论贲门失弛缓症患者存在明显动力障碍,小气囊扩张联合肉毒碱局部注射治疗效果明显,且不会造成胃食管反流。
[Objective] To study the changes of combining small balloon dilatation with endoscopic botulinum toxin A injection on achalasia. [Methods] OTW balloon dilation with 2.5 kPa lasting 10-30 seconds was performed 2, 3 times and lower intraesophageal sphincter botulinum toxin A （BTA） local injection on 38 cases of achalasia, monitoring with endoscope and X radiographe. The lower esophageal sphincter pressure （LESP） and relaxant rate （LESRR）,24 h esophageal PH were measured with esophageal manometry and 24 h esophageal PH merry （CTD Synectics PC polyrat）, and the constructure of the cardia sphincter is scanned with endoscopic before and after balloon dilatation and botulinum toxin A injection in 38 patients with achalasia. [Results] The LESP was （7.59± 1.43） kpa and the LESRR （30.45±3.36）% before dilatation and local injection, compared with the LESP（3.12±1.57） kPa and LESRR （60.87±3.48）% after this therapy. There is significant difference in esophagus kinematics （〈0.01）. No marked changes of esophageal 24h PH can be found before and after this therapy. Symptoms of dysphagia and regurgitation disappear on 38 patients of achalasia. There are no complications. [Conclusions] There are distinct abnormality of the esophageal motility in the achalasia. Anyway no changes of constructure of the cardia sphincter and intraesophageal 24h motility PH are observed. Combining small balloon dilatation with endoscopic botulinum toxin A injection is a good therapeutic method for achalasia.
出处
《中国内镜杂志》
CSCD
北大核心
2006年第1期76-78,81,共4页
China Journal of Endoscopy
