肝硬化门静脉高压症断流术后贲门失迟缓的诊治

Diagnosis and treatment of post-operative achalasia after pericardial devascularization in patients with portal hypertension from liver cirrhosis

目的：探讨肝硬化门静脉高压症行贲门周围血管离断术后发生贲门失迟缓的诊治方法。方法：对我院2008年1月-2013年5月共行脾切除＋贲门周围血管离断术282例术后发生不同程度的贲门失迟缓的43例（15.2%）病例资料进行分析总结。结果：43例在术后出现进食梗咽感、吞咽困难,给予心理安慰、对症治疗缓解34例;另9例经鼻肠管给予肠内营养液、流质,4例缓解,余5例病人仍进食困难,进食后呕吐,行上消化道钡餐检查提示贲门线样狭窄,经内镜或介入球囊扩张治疗后缓解,其中4例经1次扩张后即缓解,1例经两次球囊扩张后缓解,目前随访中未发现症状反复。结论：门脉高压症断流术后贲门失迟缓与性别、断流位置高低、术前反复出血行腔内治疗、术中食管肌层的损伤及术中应用非吸收化学胶食管表面喷洒有一定的关系,本病应早发现早治疗,保守治疗不缓解,宜选用介入或内镜下食管球囊扩张治疗,疗效肯定。

Objective： To investigate the diagnosis and surgical approach to post operative achalasia after pericardial devasculatirzation in patients with portal hypertension resulted from liver cirrhosis. Methods： The clinical data were retrospectively examined in 43 of 282 patients undergone conventional splenectomy plus pericardial vessel devascularization complicated with post-oerative achalasia to a certain degree. Results： After operation,43 patients complained of catch sensation of food intake and dysphagia. By symptomatic treatment and psychological intervention,remission occurred in 34,and 9 were given enteral nutrition via nasojejunal tube,in which 4 were relieved and 5 remained no remission. The clinical picture included vomiting after food intake due to thread-like stenosis of cardia by the findings of barium meal X-ray for the upper digestive tract. Endoscopic balloon dilation was applied to the 5 cases,and remission occurred in 4 by one intervention and in 1 by twice. No relapse occurred in the follow-up period. Conclusion： Esophageal stenosis after pericardial devascularization is closely associated with gender,devascularization position,preoperative intravascular interventional therapy of repeated bleeding,intraoperative esophagus muscular injury and spraying esophageal mucosal surface with non-absorbing chemical glue. Early detection and treatment should be necessary for this disease,and interventional treatment or endoscopic balloon dilation is effective and recommended to the failure of conservative treatment.