大气囊扩张治疗贲门失弛缓症的临床应用

The clinical application of large pneumatic balloon dilation for achalasia of cardia

目的:评价大气囊扩张治疗贲门失弛缓症的疗效,并探讨扩张器选择及扩张技术。方法:对31例临床诊断为贲门失弛缓症患者,采用经口送入直径3.0cm,3.5cm,4.0cm的大气囊扩张狭窄的贲门管,每次扩张维持3分钟,间歇2分钟,至扩张过程中气囊切迹消失为止。一般为3～4次。结果:扩张技术成功率为97%,操作时间平均40分钟,贲门管直径平均增粗0.64cm,排空明显加快,食管下段潴留排空率平均提高38.73%。1例胸腔-食管瘘,随访结果30例吞咽困难症状明显消失,无食管反流。结论:对贲门失弛缓症,采用直径为3.0～4.0cm大气囊扩张治疗,创伤小,治愈周期短,且安全有效。

Objective:To evaluate long term efficacy of large pneumatic balloon dilation for achalasia of cardia and to approach suiable diameter of pneumatic balloon and technique of dilation.Methods:Thirty one patients were treated for achalasia of cardia by pneumatic balloon dilation,from May 1995 to March 2001,3.0cm,3.5cm,4.0cm balloon were used respectively in 31 patients,and the duration of inflation was 3min,there was an interval of 2min between two dilations.Commonly 3～4 times of dilation were used until the notch of balloon disappears.Results:The excellent-good success rates of large pneumatic balloon dilation were 97%.Mean duration of operation were 40min.The caliber of cardia was increased up to 0.65cm;Esophageal emptying was improved significantly;Emptying rates were increased up to 38.9%.In one patient esophago-pleural fistula occurred.In 30 patients dysphagia was disappeared,no regurgitation occurred in the follow up.Conclusion:The large pneumatic balloon(3.0～4.0cm)dilation for cardia achalasia has a high success rate and complications are rare.