改良型可回收金属支架治疗贲门失弛缓症疗效的初步评价

Efficacy of implantation of a modified temporary metallic stent for cardia achalasia

目的初步探讨改良型可回收金属支架治疗贲门失弛缓症的疗效及安全性。方法30例确诊为贲门失弛缓症患者随机分成两组，普通型支架（A组）和改良型支架（B组）各15例，在胃镜直视下置入支架于贲门处，2d后在x线引导下通过胃镜将支架取出。分别记录治疗前及治疗半年后患者吞咽困难、下食管括约肌（LES）静息压及食管X线表现（包括食管最扩张处直径、贲门最狭窄区宽度）的变化情况；支架置入时与2d后取出时X线下支架最狭窄处的宽度变化；治疗过程中不良反应及并发症情况。结果30例支架置入和取出的成功率为100％，置入后A组有2例发生支架脱落，取出后重新置入，B组无一例出现移位和脱落。支架治疗半年后患者吞咽困难与治疗前相比两组均有明显改善（P〈0．05）；但半年后吞咽困难复发率A组（26．7％）明显高于B组（6．67％）（P〈0．05）；支架治疗前后X线下食管腔最大扩张程度两组均有明显改善（P〈0．001），贲门最狭窄区直径、支架放置后和取出时最狭窄处直径及LES静息压两组较治疗前均有明显改善，但改善程度B组显著优于A组（P〈0．05）。治疗时及治疗后不良反应发生率两组无统计学差异，两组均无穿孔。结论改良型可回收金属支架治疗贲门失弛缓症具有放置时间短、无移位脱落、症状改善明显及复发率低等优点，且安全性良好。

Objective To study the efficacy and safety of implantation of a modified temporary self- expanding metallic stent for cardia achalasia. Methods A total of 30 patients diagnosed as having cardia aehalasia were randomly divided into 2 groups, group A （traditional stents） and group B （modified stents） （n = 15 in each group）. Two clays after stent implantation at the cardia by endoscopy, stents were withdrawn with endoscope guided by X-ray. LES Pressure, X-ray images （including the diameter of the most dilated part of esophageal and the most narrow part of cardia） and the symptoms of dysphagia were compared before and half year after the treatment. The width changes of the most narrow stenting part on the point of stenting and 2 days after removal were compared. The side effects and complications during the treatment were recor- ded. Results All thirty stents were successfully implanted and removed. Stent dislocation occnred in 2 ca- ses in group A, but none in group B. Dysphagia had significant improvement after the treatment in both groups （ P 〈 0. 05 ）, but the recurrence rate of group A （26. 7% ） was significantly higher than group B （6. 67% ） in 6 months （ P 〈 0. 05）. LES pressure and X-ray images of both groups significantly improved af- ter treatment （ P 〈 0. 001 ）, and those of group B were superior to group A （ P 〈0. 05 ）. There was no differ- ence in adverse reaction between the two groups. No perforation occured in any group. Conclusion Self-ex- panding metallic stents is safe for patients with cardia achalasia, with implantation convenience, symptomaticimprovement, low recurrence, and few complications or dislocation.