内镜下治疗贲门失弛缓症的临床研究

Endoscopic Treatment of Achalasia:Clinical Research

目的探讨内镜下治疗贲门失弛缓症的方法、效果及安全性。方法 27例患者随机分为两组:支架放置组11例,经内镜安装可回收全覆膜防反流支架,术后2个月回收支架;扩张组16例,行内镜下探条或气囊扩张。在治疗后6、12、18个月时随访,了解临床症状改善情况。结果 11例支架放置组患者,支架均成功置入并顺利取出,无严重并发症发生。扩张组16例中有2例术后并发贲门黏膜撕裂大出血,无1例发生穿孔。在治疗后6个月随访两组患者咽下困难缓解率均达到100%。16例扩张组患者18个月后有5例复发(31.3%),临床症状≥Ⅱ级,11例支架组患者18个月后只有1例临床症状为Ⅰ级(9.1%),支架放置组较扩张组疗效更显著(P<0.01)。结论内镜下治疗贲门失弛缓症的远期疗效理想,可作为贲门失驰缓症的首选和主要的治疗方法。

Objective To explore the method, effectiveness and safety in the treatment of achalasia by using endoscopy. Methods Twenty-seven eases were randomly divided into two groups： stent placement group （11 cases） in which all coated anti-reflux stents by endoscopic installation were reclaimed 2 months after operation, and expanded group （16 eases）, in which endoscopic test rod or balloon dilatation was carried out. 6, 12 and 18 months after treatment, all cases were followed up and the improvement of their clinical symptoms was observed in the two groups. Results The stents were successfully implanted and removed successfully without severe complications in the stent placement group. Mallory-Weiss bleeding in 2 cases and no perforation occurred in the expanded group. The dysphagia remission rate of the two group reached 100% 6 months after treatment. In the expanded group there was recurrence in 5 eases （31.3%） after 18 months, with their clinical symptoms ≥ grade II. In the stent placement group, there was recurrence in one case, with its clinical symptoms as grade I （9.1%）,with a significant difference between the two groups（P〈0.01）. Conclusion It can be the first choice of recycling anti-reflux stent by endoscopic installation for achalasia.