高分辨率测压法对球囊扩张治疗贲门失弛缓症的疗效预测价值

The predictive value of achalasia subtyped by high-resolution manometry in the therapeutic outcomes of pneumatic dilatation

目的:探讨贲门失弛缓症不同亚型的临床特征及高分辨率测压法对亚型的诊断在经内镜球囊扩张治疗中的疗效预测价值。方法:经胃镜及钡餐、高分辨率测压法确诊的39例贲门失弛缓症患者,依据芝加哥分型诊断标准分为3个亚型,比较不同亚型的临床特征及球囊扩张疗效。结果:在所有患者中,Ⅰ型患者10例(10/39,25.6%),Ⅱ型患者26例(26/39,66.7%),Ⅲ型患者3例(3/39,7.7%);反流在Ⅰ型患者中多见,而胸痛则在Ⅲ型患者中多见,吞咽困难及体质量下降在各亚型间无差异(P>0.05);其中37例患者接受球囊扩张治疗(Ⅰ型,9/10;Ⅱ型,25/26;Ⅲ型,3/3),随访6个月后进行疗效评价,有效率分别为Ⅰ型44.4%(4/9);Ⅱ型88%(22/25),Ⅲ型0%(0/3);Ⅱ型患者的疗效显著优于Ⅰ型及Ⅲ型(P=0.008和P<0.001);多变量logistic回归分析显示Ⅱ型是一个判断球囊扩张疗效的阳性预测因子(OR=8.000)。结论:经内镜球囊扩张治疗Ⅱ型贲门失弛缓症患者的疗效优于其他亚型;高分辨率测压法对贲门失弛缓症分型是判断经内镜球囊扩张疗效的预测因子。

Objective To investigate the clinical characteristics of different achalasia subtypes based on the high-resolution manometry （HRM） and to evaluate the predictive value of subtyping in the therapeutic outcomes of pneumatic dilatation under endoscopy （PD）. Methods Thirty-nine achalasia patients who were diagnosed by HRM, gastroscopy and esophageal barium meal radiography were categorized into 3 subtypes according to the Chicago classification. The clinical characteristics and treatment outcomes were compared among the three subtypes. Results Totally, 10 of 39 （25.6%） patients were classified as type I , 26 of 39 （66.7%） were type lI and 3 of 39 （7.7%） were type Ill, respectively. Regurgitation occurred more frequently in type I patients and chest pain was more commonly seen in type m patients. Thirty-seven patients were treated with PD （type I, 9/10; type II , 25/ 26; type m, 3/3） and with a minimum follow-up period of 6 months. Patients with type ]I had the best response to PD （22/25, 88.0%） compared to those with type I （4/9, 44.4%） and type m （0/3, 0%） after 6 months of follow-up. Conclusions The patients with type II achalasia showed a better response rate to PD compared to those with other two subtypes. Achalasia subtyped by HRM can be a good predict factor for PD.