不同直径暂时性贲门支架成形术治疗贲门失弛缓症的远期随访

Long-term follow-up study of dilation with temporary cardia stent in different diameters for achalasia

目的通过长期随访研究探讨不同直径暂时性贲门支架成形术治疗贲门失弛缓症远期疗效。方法135例贲门失弛缓症患者根据暂时性贲门支架直径分为3组,其中20 mm组(A组)30例；25 mm组(B组)30例；30 mm组(C组)75例。135例贲门失弛缓症患者中放置135枚暂时性贲门支架。支架放置后3～5 d,采用内镜取出。所有支架安放和取出成功率100%,无操作死亡。结果3组介入治疗前后贲门管腔直径、吞咽困难评分差异都有显著性(P＜0．01)。A组随访半年、1、3、5、8和10年以上患者吞咽困难复发率分别为6/30(20．0%)、6/30(20．0%)、5/22(22．7%)、6/16(37．5%)、5/9和3/3；B组随访大于等于半年、1、3、5、8年和10年以上患者吞咽困难复发率分别为4/30(13．3%)、4/30(13．3%)、3/23(13．0%)、4/18 (22．2%)、5/11(45．5%)和3/4；C组随访大于等于半年、1、3、5、8年和10年以上患者吞咽困难复发率分别为0/75(0%)、1/66(1．5%)、4/48(8．3%)、6/33(18．2%)、6/18(33．3%)和2/5。结论30 mm直径作暂时性贲门支架成形术是贲门失弛缓症暂时性支架成形术中的最佳选择。

Objective To determine the curative effect of dilation for achalasia with temporary cardia stent in different diameters based on a long-term follow-up. Methods The study cohort was comprised of 135 patients of achalasia. Among them differentiated by stent diameters as followings：30 patients were treated under fluoroscopy with dilation of temporary cardia stent in 20 mm diameter （group A）, 30 patients with dilation of temporary cardia stent in 25 mm diameter（group B）, and 75 patients with dilation of temporary cardia stent in 30 mm diameter（group C）. 135 cardia stents were temporarily placed in the 135 patients and withdrawn after 3 - 5 days via gastroscopy. All the stents were inserted and withdrawn successfully. The follow-up in all groups lasted 6 - 128 months. Results Six （20.0%）out of 30 patients, 6（20.0%）out of 30 patients, 5（22.7%）out of 22 patients, 6 （37.5%）out of 16 patients, 5 out of 9 patients, 3 out of 3 patients in group A exhibited dysphagia relapse during 6 months, 1 year, 3 years, 5 years , 8 years, and 10 years follow-up, respectively. Four（13.3%）out of 30 patients, 4（13.3%） out of 30 patients, 3（13.0%） out of 23 patients, 4（22.2%） out of 18 patients, 5（45.5%）out of 11 patients, and 3 out of 4 patients in group B exhibited dysphagia relapse during 6 months, 1 year, 3 years, 5 years, 8 years, and 10 years follow-up, respectively. No（0.0%）out of 75 patients, 1 （1.5%）out of 66 patients, 4（8.3%） out of 48 patients, 6（18.2%） out of 33 patients, 6（33.3%） out of 18 patients, 2 out of 5 patients in group C exhibited dysphagia relapse during 6 months, 1 year, 3 years, 5 years, 8 years, and 10 years follow-up, respectively. Conclusion Dilation with temporary cardia metal stent in 30 mm diameter is the best dilation for aehalasia in long-term follow-up.