一例贲门失弛缓症患者的循证治疗

Evidence-Based Treatment for a Patient with Achalasia

目的借助循证医学方法为1例贲门失弛缓症患者确定治疗方案。方法在评估患者情况后针对该例患者情况提出临床问题,通过计算机检索Cochrane图书馆(1990～2010)、PubMed(1980～2010),查找并评价贲门失弛缓症治疗相关的最佳临床证据。结果共检索到33篇文献,包括29个随机对照试验和4个系统评价,其对药物治疗、内镜下肉毒杆菌注射、内镜下球囊扩张治疗和外科治疗贲门失弛缓症的疗效和安全性进行了评价。我们结合患者的症状、年龄、合并疾病情况,向患者推荐内镜下球囊扩张治疗或经腹腔镜行Heller术后加Dor胃底折叠术。患者最终选择内镜下球囊扩张治疗,术后患者症状明显好转。结论采用循证治疗方法,为贲门失弛缓症患者确定合理的治疗方案,不仅可有效提高治疗效果,同时有利于引导医患双方共同承担不确定的风险。

Objective Through the methods of evidence-based medicine,to make an individualized treatment plan for a patient with achalasia.Methods Based on an adequate assessment of the patient＇s condition,clinical issues aimed at this case were put forward.And the best clinical evidence related to achalasia treatment was evaluated after being retrieved from The Cochrane library（1990 to 2010） and PubMed（1980 to 2010）.Results 33 studies were retrieved including 29 RCTs and 4 systematic reviews.The efficacy and safety of drug therapy,endoscopic injection of botulinum,endoscopic balloon dilatation and surgical therapy were evaluated.Cosidering symptoms,age and comorbidities,we recommended endoscopic balloon dilatation or laparoscopic Heller postoperative plus Dor fundoplication surgery for treatment.The patient＇s choice is endoscopic balloon dilatation.Symptoms of patient were relieved after treatment.Conclusion Making a rational therapeutic plan for achalasia patients by means of evidence-based treatment not only can improve therapeutic effect but also be beneficial for both doctors and patients to share uncertain risks.