大直径球囊扩张治疗80例贲门失弛缓症的中远期疗效评价分析

Large-diameter balloon dilation for the treatment of achalasia of cardia: an analysis of mid-to-long term efficacy in 80 cases

目的探讨并总结大直径(40 mm)球囊扩张治疗贲门失弛缓症的方法及中远期疗效。方法 80例患者病程3～23年。Mellow-Pinkas吞咽困难分级(0～4级)为:Ⅰ级6例,Ⅱ级60例,Ⅲ级14例;均经钡餐透视(12例行胃镜检查)证实。在2%利多卡因咽部喷雾麻醉下,以球囊间歇(间隔3～5 min)、逐渐扩张贲门狭窄部至球囊最大径40 mm,重复2～3次。术后常规预防出血和感染,2～3 h即可进食较凉流质饮食、3 d内进半流质饮食并逐渐过度为正常进食。术后随访问2～10年。结果操作成功率100%,其中1次操作治疗成功96.3%(77/80),2次扩张(3例先经小球囊预扩)成功3.7%(3/80)。术后破裂行手术修补1例(1.2%)。术后随访平均6.27年,其中大于10年4例,6～10年44例,3～5年21例,2年11例,吞咽困难缓解率100%,其中能正常进食90%(72/80),正常进食时偶有轻度梗噎感10.0%(8/80)。轻度食管反流占15.0%(12/80)。结论从患者接受程度、疗效及并发症等综合评价,大直径球囊扩张术是目前治疗贲门失弛缓症的最佳方法。具有操作简单、创伤小、费用低且中远期疗效较好的优点,可作为成年人贲门失弛缓症的首选治疗方法。

Objective To discuss the technical points of large-diameter（40 mm） balloon dilation in treating achalasia of cardia,and to assess its mid-to-long term efficacy.Methods A total of 80 patients of achalasia of cardia with a disease course of 3-23 years were enrolled in this study.According to Mellow-Pinkas standard of the dysphagia grading（from 0 to IV）,the patients were classified into grade Ⅰ（n = 6）,grade Ⅱ（n = 60） and grade Ⅲ（n = 14）.The diagnosis was confirmed by barium meal examination in all patients.Under spraying anesthesia of pharyngeal portion with 2% lidocaine,the intensified guide wire was inserted into the stomach through mouth under fluoroscopy guidance.The Boston＇s balloon（40 mm in diameter） was pushed along the guidewire to the stricture site at the cardia and was gradually inflated with 15% contrast medium by using the ＂graded intermittent inflation＂ technique.Namely,the balloon was inflated to a maximum diameter and was kept in this condition for five minute,and then the balloon was deflated for 3-5 minutes.The above procedure was repeated 2-3 times.For the severe stricture,pre-dilatation with 20-25 mm diameter balloon was carried out.As a routine,postoperative measures to prevent possible bleeding and infection were adopted.The patient was allowed to take cool liquid diet 2-3 hours after the procedure,to have semi-liquid diet within three days and then to take normal diet.The patients were followed up for 2-10 years.Results The balloon insertion was technically successful in all of the 80 patients.The success rate of single and twice manipulations was 96.3%（77/80） and 3.7%（3/80）,respectively.Postoperative rupture of the cardia region was seen in one patient,and surgical repair had to be carried out.The follow-up time ranged from 2 years to 10 years（mean 6.27 years）.No recurrent stenosis occurred in all patients.The remission rate of dysphagia was 100%.The swallowing function returned to normal in 90% of patients（72/80）.Mild esophageal reflux occurred in 12 patients.Conclusion For the treatment of achalasia of cardia,dilatation with large-diameter balloon is technically-simple,minimally-invasive,effective and economical,and the mid-to-long term efficacy is fine and reliable.Therefore,this technique should be regarded as the treatment of first choice for adult patients.