暂时性金属内支架扩张术介入治疗贲门失弛缓及其中远期疗效分析

Interventional therapy of achalasia with temporary metal internal stent dilatation and its intermediate and long term follow-up

目的探讨暂时性金属内支架扩张术在贲门失弛缓介入治疗中应用及其中远期疗效随访。方法 20例贲门失弛缓患者,在 X 线引导下置入国产带膜支架,术后3d～7d,由内镜取出,20例贲门失弛缓患者安放暂时性金属内支架20只(其中20mm 直径支架12只;25mm 直径支架8只),治疗前所有患者均有不同程度的吞咽困难,并给予食管下段括约肌(LES)静息压力测定。结果 20例患者支架置入和支架取出成功率均为100%,操作死亡率为0%,支架置入后吞咽困难明显好转,吞咽困难评分0级;贲门管腔直径20 mm 和25mm,平均(22±3)mm,暂时性支架扩张术后,贲门狭窄直径明显高于治疗前、吞咽困难评分明显低于治疗前、LES 静息压明显降低(P<0.001);支架置入前,食管管腔直径1～9(平均5±4) mm;支架取出1wk 内管腔直径为10～18(平均14±3)mm.吞咽困难评分术前为2～3(平均2.4±0.3)级;支架取出后吞咽困难评分为0～1(平均O.5±0.3)级支架置入前 LES 静息压力为40～66(平均53±10)mmHg(1mmHg=0.133kPa);支架取出后 LES 静息压力为0～20(平均10±8)mmHg.支架置入后并发症有胸部胀痛12例,反流8例,支架取出后少量出血3例,反流2例,所有并发症均给予有效处理,所有患者术后随访6～26(平均16.5±9.3)mo.随访期内使用直径20mm 支架的患者有3例(15%)在治疗后6mo 内复发吞咽困难,17例(85%)在随访期内吞咽能力明显好转。结论暂时性金属内支架扩张术是贲门失弛缓介入治疗中最有效的方法之一,且中远期疗效较好.

AIM To study achalasia with temporary metal internal stent dilation and its intermediate and long term follow-up result. METHODS Twenty patients with achalasia were placed with 20 covered stents and 2D patients with temporary metal internal stent under X-ray control(12 stents of 20 mm diameters;8 stents of 25 mm diameters).All patients had different grade dysphagia.After stent dilation for 3-7 days,the stents were removed by endoscopy. RESULTS Temporary metal internal stent dilation was technically successful and dysphagi8 was effectively remitted in 811 patients.The dysphagi8 scores were from 2 to 3(mean 2.4±0.3)grade before stent dilation,and 0 grade after stent dilation,and from 0 to 1(0.5± 0.3) grade after stent removal.The diameters of cardia lumen were 1 mm-9 mm(mean 5±4)before stent dilation and from 20 mm-25 mm(mean 22±3)after stent dilation,and from 10 mm-18 mm(mean 14±3)after stent removal. Lower esophageal sphincter(LES)residual pressure was 40 mmHg-66mmHg(mean 53±10)(1 mmHg=0.133 kPa) before stent dilation and 0 mmHg-20 mmHg(mean 10±8) after stent removal.Follow-up time was from 6-26 months(mean 16.5±9.3).Three(15%)patients used stents of the 20mm diameters had recurrence of dysphagia within six-month follow-up.Seventeen(85%) patients had swallowing improved within the follow-up. The complications were chest pain(n=12)and reflux (n=8)after stent dilation and bleeding(n=3)and refulx (n=2)after stent removal. CONCLUSION Temporary metal internal stent dilation had better result in the intermediate and long-term follow-up and was one of the most effective methods in interventional therapy for achalasia.