内镜直视下机械扩张治疗贲门失弛缓症62例

Endoscopic Mechanical Dilation for Cardia Achalasia:Roport of 62 Cases

目的评价内镜直视下机械扩张治疗贲门失弛缓症的疗效。方法利用自行设计并改良的机械扩张器械在上消化道内镜直视下对62例贲门失弛缓症进行机械扩张。其中1例为Heller手术失败,4例为气囊扩张失败。结果2例食管破裂中转开胸手术治愈;1例不能耐受手术而放弃;1例一次扩张效果不好,二次扩张后痊愈;其余58例一次成功。扩张时间2～5min,平均3.5min。术中均见黏膜少量出血,无活动性出血。术后2小时进冷流质饮食,6小时后软成形饮食,之后过渡为普通饮食。58例随访2～11年,平均7.5年,均获治愈。结论内镜直视下机械扩张贲门失弛缓症创伤小,费用低,无反流,长期随访效果可靠,有推广价值。

Objective To evaluate the effect of mechanical dilation on cardia achalasia under an endoscope. Methods A total of 62 patients with cardia achalasia were treated with mechanical dilation by using a self-designed dilator under a gastroscope. Of the cases, one had experienced a failure of heller surgery, and four had received ballon dilation before the gastroscopy. Results Among the cases, 2 were convered to open thoracic surgery becaues of rupture of the esophagus, 1 patient could not tolerate the operation, 1 received a second dilation because of unsatisfied outcome of the first attempt. In the other 58 patients, the surgery was completed in the first attempt. The mean dilation time was 3.5 minutes （ ranged from 2 to 5 minutes）. Slight mucosal hemorrhage was observed during the operation, while no continuous bleeding occurred. Cold liquid diet was given to the patients 2 hours after the dilation, and then semiliquid diet was prescribed in 6 hours, after that the patients began to take normal diet gradually. The patients were followed up for 2 to 11 years with a mean of 7.5. All of them were cured without recurrence. Conclusions Endoscopic mechanical dilation is microinvasive, safe, and effective for cardia achalasia. It is worth being widely used because of a low cost and reliable long-term outcomes.