金属支架和球囊扩张治疗贲门失弛缓症对食管动力影响的比较

Effect on esophageal motility in achalasia using metal internal stent comparison with endoscopic balloon dilation

目的探讨暂时性金属支架和内镜下球囊扩张治疗贲门失弛缓症对食管动力的影响。方法26例贲门失弛缓症患者,随机分为两组,其中一组,置入可扩张带膜金属支架,术后3 d取出。另一组用Regiflex球囊扩张器在内镜下扩张治疗,治疗前、后2周和2年测定LES静息压、松弛率、食管内24 h pH监测,12例健康人测定LES静息压、松弛率。结果扩张后2周支架组和球囊组LES静息压、松弛率、胃食管反流率无显著差异(1.72±0.78 kPavs1.90±0.99 kPa、76.66%vs78.26%、27.72%vs28.26%,P>0.05),且支架组和球囊组LES静息压、松弛率与正常人组无显著差异(1.72±0.78 kPavs1.90±0.99 kPavs1.90±0.82 kPa、76.66%vs78.26%vs90.00%,P>0.05)。扩张后2年支架组LES静息压显著低于球囊组(1.89±0.98 kPavs4.15±0.15 kPa,P<0.05),而松弛率和胃食管反流率显著高于球囊组(73.46%vs23.46%、66.12%vs4.67%,P<0.05.),支架组LES静息压、松弛率与正常人组无显著差异(1.89±0.98 kPavs1.90±0.99 kPa、73.46%vs90.00%,P>0.05)。结论金属支架和内镜球囊扩张治疗贲门失弛缓症对食管动力的影响近期基本相同,在中远期暂时性金属支架扩张术仍能显著降低贲门失弛缓症患者的LES压力,但胃食管反流也显著增加。

Objective To explore the effect of temporary metal internal stent and endoscopic balloon dilation on esophageal motility with achalasia. Methods Twenty six patients were randomly divided into two groups： metal stent group and balloon group. The patients in metal stent group were placed temporary metal intenal stent, and the stents were removed after 3 days. The patients in balloon group were treated by Regiflex balloon. LES pressure, LES relax rate and 24 h pH were performed on 2 patient groups and LES pressure, LEG relax rate were also performed on 12 healthy subjects （HS） as control. Results Esophageal motility indices in cluding LEG pressure, LEG relax rate and GER had no significant difference between metal stent group and balloon group after dilation for two weeks（1.72 ± 0. 78 kPa vs 1.90 ± 0.99 kPa, 76.66 % vs 78.26 % ,27.72 % vs 28.26 %, P 〉0.05）. LES residual pressure and relax rate also had no significant difference between HS and other two groups after two dilation weeks （ 1.72 ± 0.78 kPa vs 1.90 ± 0.99 kPa vs 1.90 ± 0.82 kPa, 76.66 % vs 78.26 % vs 90.00 %, P 〉 0.05）. LES residual pressure had significant difference between metal stent group and balloon group（ 1.89 ± 0.98 kPa vs 4.15 ± 0.15 kPa, P 〈 0.05 ）. The LES relax rate and frequency of gastroesophageal reflux in metal stent group were markedly higher than that in balloon group. Residual pressure and relax rate had no significant differences between HS and metal stent group after two years （1.89±0.98 kPa vs 1.90±0.99 kPa,73.46% vs 90.00% ,P〉0.05）.Conclusion Metal stent had lower LES pressure and higher rate of GER for achalasia than endoscopic balloon dilation in long term.