贲门失弛缓三种介入治疗方法选择和中远期疗效分析

Method selection and evaluation of midtrimester and long term therapeutic efficiency of achalasia with three methods of interventional procedure

目的 探讨贲门失弛缓有效的介入治疗方法 ,并分析 3种介入治疗方法中远期疗效。方法 5 0例食管贲门失弛缓患者。其中球囊导管扩张术组 (A组 ) 30例 ;永久性金属内支架扩张组 (B组 )5例 ;暂时性金属内支架扩张术组 (C组 ) 15例。C组术后 3～ 7天由胃镜取出支架。结果 A组 30例共进行 5 6次球囊扩张 ,平均 1.9次。其中 13例增加直径分级扩张 3次 ;17例扩张 1次。B组 5例 ,安放不带膜支架 5只。C组 15例 ,安放部分带膜支架 15只 ,术后均用胃镜取出。A组贲门管腔直径术前为 (2 .4± 1.2 )mm ,术后为 (9.7± 3.0 )mm ;吞咽困难评分术前为 (2 .4± 1.2 )级 ,术后为 (1.0± 0 .3)级 ;主要并发症为疼痛和反流。超过 6个月的随访患者中 6 0 % (18/30 )复发吞咽困难 ,超过 1年的随访患者中90 % (18/2 0 )复发吞咽困难。B组贲门管腔直径术前为 (3.2± 2 .0 )mm ,术后为 (18.4± 1.7)mm ;吞咽困难评分术前为 (2 .4± 1.1)级 ,术后为 (0 .4± 0 .2 )级 ;主要并发症为疼痛、反流、出血和肉芽增生。超过 6个月的随访患者中 6 0 % (3/5 )复发吞咽困难 ,超过 1年的随访患者中 5 0 % (1/2 )复发吞咽困难。C组贲门管腔直径术前为 (3.4± 2 .9)mm ,术后为 (14.7± 2 .9)mm ;吞咽困难评分术前为 (2 .5± 1.1)级 。

Objective To study method selection and evaluation of midtrimester and long term therapeutic effciency of achalasia with three methods of interventional procedure. Methods 50 cases achalasia with 30 cases performing with balloon dilation (group A) and 5 cases with permanent metallic internal stent dilation (group B) and 15 cases with temporary metallic internal stent dilation (group C) under fluoroscopy. Results 30 cases of group A had 56 times of dilations (mean 1.9 times). The mean diameter of cardia was (2.4± 1.2 )mm before dilation and (9.7±3.0)mm after dilation. The mean dysphagia scores were 2.4±1.2 grades before dilation and 1.0±0.3 grades after dilation. Complications in 30 cases included chest pain ( n =9), reflux ( n =8) and bleeding ( n =3). 18(60%) of 30 cases showed dysphagia relapse during follow up over 6 months, 18(90%) of 20 cases showed dysphagia relapse during follow up over 12 months. 5 uncovered expandable metal stents were permanently placed in 5 cases of group B. The mean diameter of cardia was ( 3.2 ± 2.0 )mm before dilation and (18.4±1.7)mm after dilation. The mean dysphagia scores were ( 2.4 ± 1.1 ) grade before dilation and (0.4±0.2) grade after dilation. Complications in 5 cases included chest pain ( n =3),reflux ( n =4), bleeding ( n =1) and hyperplasia of granulation tissue ( n =2). 3(60%) in 5 cases showed dysphagia relapse during follow up over 6 months, 1(50%) in 2 cases were dysphagia relapse during follow up over 12 months. 15 covered expandable metal stents were temporarily placed in 15 cases of group C and drawn out at the 3～7 days via gastroscopy. The mean diameter of cardia was (3.4±2.9)mm before dilation and (14.7±2.9)mm after dilation. The mean dysphagia scores were (2.5±1.1) grades before dilation and ( 0.6 ± 0.3 ) grades after dilation. Complications in 15 cases included chest pain ( n =3), reflux ( n =3) and bleeding ( n =2). 3(20%) in 15 cases showed dysphagia relapse during follow up over 6 months, 2(20%) in 10 cases had dysphagia relapse during follow up over 12 months. All stents insertion and drawing were technically successful. Follow up time of group A, B and C were from 6 months to 33 months.Conclusions The effective method for curing achalasia with interventional procedrue were graded balloon dilation and temporary metal internal stent dialation. Temporary metal internal stent dilation was first method of choice for achalasia with interventional procedure in midtrimester and long term therapeutic efficiency.