脾切除联合贲门周围血管离断术后并发贲门失弛缓的上消化道造影表现

Observation of upper gastrointestinal contrast for patients with achalasia after splenectomy combined with pericardial devascularization

目的探讨肝硬化门静脉高压症患者行脾切除联合贲门周围血管离断术后并发贲门失弛缓的上消化道造影表现。方法选择2012年2月至2016年7月阜阳市第二人民医院行脾切除联合贲门周围血管离断术后出现进食梗噎感、吞咽困难的38例患者,回顾性分析患者进行钡餐或碘水造影的病例资料,总结其影像学表现。结果上消化道造影的食管轻、中和重度扩张分别为15例(39.5%)、22例(57.9%)和1例(2.6%);食管下端狭窄段长度3.0~5.0 cm计26例(68.4%),5.1~7.0 cm计12例(31.6%);最窄处直径3.0~6.0 mm 15例(39.4%),7.1~10.0 mm 23例(60.6%),且狭窄段均边界光滑;38例均见食管蠕动减慢、排空延迟;有14例患者仍见中下段食管静脉曲张;9例胃空腹潴留物多。结论脾切除联合贲门周围血管离断术后并发贲门失弛缓是临床常见病症,影像学上主要依据病史和典型的上消化道造影表现作出诊断。

ObjectiveTo investigate the manifestations of upper gastrointestinal contrast for patients with achalasia after splenectomy combined with pericardial devascularization.MethodsThe clinical data of thirty-eight patients with achalasia were retrospectively analyzed.All patients underwent splenectomy and pericardial devascularization from February2012to July2016in our hospital,present with dysphagia.The imaging findings of upper gastrointestinal contrast were summarized.ResultsThe mild,moderate and severe degree of esophageal dilatation were found in15cases(39.5%),22cases(57.9%)and1case(2.6%)respectively;the stenosis length of the lower esophageal distributed in26cases(68.4%)of3.0~5.0cm of and12cases(31.6%)of5.1~7.0cm;the diameter of the most narrow segment was3.0~6.0mm in15cases(39.4%),and7.1~10.0mm in23cases(60.6%).Esophageal peristalsis slow and emptying delay were found in all38patients,esophageal varices in14patients,and gastric retention in9patients.ConclusionAchalasia is a common clinical symptom in patients treated with splenectomy combined with pericardial devascularization.The radiographic diagnosis is mainly based on the history and typical imaging manifestations.