内镜下三种方法治疗贲门失弛缓症后下食管括约肌及体部动力学比较

Compare the kinetics of lower esophageal sphincter and esophageal body of achalasia after treated by three methods under endoscope

目的 比较分析内镜下单纯扩张术、扩张加肉毒杆菌毒素注射术及支架扩张术治疗贲门失弛缓症后下食管括约肌（LES）及食管体部动力学变化情况.方法 将99例临床确诊的贲门失弛缓症患者分为扩张组、扩张注射组和支架组,分别进行内镜下单纯扩张术、扩张加肉毒杆菌毒素注射术及支架扩张术治疗,并于治疗前、治疗后1周、治疗后6个月及治疗后12个月分别检测LES静息压、松弛率及食管体部顺行性收缩比例、非协调性收缩比例、LES上10 cm处的收缩幅度,比较分析治疗前后各项指标的变化值.结果 治疗前,各组LES静息压、食管体部非协调性收缩比例、收缩幅度均较正常值显著升高,LES松弛率及食管体部顺行性收缩比例则均显著降低,3组间差异无统计学意义.治疗后1周,3组间各项检测指标与术前比较的变化值差异均无统计学意义.治疗后6个月,扩张注射组和支架组LES静息压、LES松弛率、食管体部收缩幅度的改善情况均优于扩张组,P值分别为0.041、0.006、0.037和0.029、0.004、0.033,但扩张注射组和支架组间比较差异无统计学意义（P值均＞0.05）.治疗后12个月,支架组LES静息压、LES松弛率、食管体部顺行性收缩比例、食管体部收缩幅度的改善情况均优于扩张组,P值分别为0.035、0.028、0.008、0.007,扩张注射组与扩张组比较则差异均无统计学意义（P值均＞0.05）.结论 内镜下单纯扩张术、扩张加肉毒杆菌毒素注射术及支架扩张术是治疗贲门失弛缓症的有效方法 ,近期疗效显著,远期复发率随时间延长均呈上升趋势,但支架扩张术的远期疗效相对优于其他两种方法 .

Objective To compare and analyze the kinetics changes of lower esophageal sphincter （LES） and esophageal body of achalasia after treated by simple dilation, dilation with botulinum toxin injection and stenting under endoscope. Methods The 99 clinical diagnosed achalasia cases were divide into simple dilation group, dilation with botulinum toxin injection group and stenting group, which were treated with simple dilation, dilation with botulinum toxin injection and stenting respectively. The resting pressure of LES, relaxing ratio, the percentage of concordant and discordant contraction of esophageal body and the contraction range at 10 cm above LES were tested. The variation of each indicator was compared and analyzed before and after the operation. Results Before treatment, the value of the resting pressure of LES, the percentage of discordant contraction,contracting amplitude of esophageal body was higher than normal, while the relaxing ratio of LES and percentage of concordant contraction of esophageal body was lower. There was no significant difference between 3 groups. One week after the treatment, there was no statistic difference in the variation of each indicator compared with pre-operation in 3 groutps. Six months after the treatment, theimprovement of LES resting pressure, relaxing rate and contracting amplitude of esophageal body in dilation with injection group and stenting group were better than those of dilation group （P was 0.041,0.006,0.037and 0. 029,0.004,0.033 respectively）. However there was no statistic difference between dilation with injection group and stenting group. Twelve months after treatment, the improvement of LES resting pressure, relaxing ratio, the percentage of concordant contraction and contracting amplitude of esophageal body in stenting group were better than those of dilation group （P was 0.035,0.028, 0. 008, and 0. 007 respectively）. However there was no statistic difference between dilation with injection group and simple dilation group. Conclusion Simple dilation, dilation with botulinum toxin injection and stenting are effective methods of achalasia treatment. The effect in near future is significant, while the long-term recurrence is in rising trend as time extension. The effect of stenting is better than the other two methods in the long-term.