三种方法治疗贲门失弛缓症效果观察

目的观察比较内镜下球囊扩张术、胸腔镜Heller手术及开胸Heller手术治疗贲门失弛缓症的中远期效果。方法内镜/钡餐检查诊断为贲门失弛缓症的53例患者按治疗方法分为:内镜下球囊扩张术治疗组(扩张组)14例,胸腔镜Heller手术治疗组(胸腔镜组)11例,开胸Heller手术治疗组(开胸组)28例。比较各组治疗前后症状、食管中下段直径及食管pH值;以首次扩张治疗后6个月~1年为中期疗效、1年以上为远期疗效,计算该疗法的中远期有效率。结果开胸组和胸腔镜组近期疗效均优于扩张组(P均<0.05),三组中期疗效及胸腔镜组远期疗效均达100%,开胸组远期疗效为97.73%,扩张组远期疗效为86.96%。3例复发再次扩张治疗后症状缓减。无食管大出血、穿孔等严重并发症发生。结论内镜下球囊扩张术、胸腔镜Heller手术及开胸Heller手术治疗贲门失弛缓症均具有良好的中远期疗效。球囊扩张术可经门诊治疗、操作简便、疗效确切、费用低廉、创伤小,是贲门失弛缓症的首选治疗方法;外科手术治疗为最有效的方法,但不作为首选方法。

The efficacy of three methods in the treatment of cardia achalasia

Objective To analyze the mid-and long-term efficacy of endoscopic balloon dilatation,Heller thoracoscopic surgery and open heart surgery Heller in cardia achalasia.Methods 53 patients with cardia achlasia were diagnosed by endoscopic/barium meal examination.14 cases underwent endoscopic balloon dilation(dilation group),11 cases underwent Heller thoracoscopic surgery(thoracoscopic group),and 28 cases underwent thoracotomy Heller(thoracotomy group).The symptoms,diameters of mid-and lower-esophagus,and esophageal pH value were analyzed in each group before and after treatment.The efficacies of medium-term(from 6 months to 1 year after treatment) and long-term(more than 1 year after treatment) were evaluated.The reponse rates of mid-and long-term were caculated.Results The medium-term results in thoracotomy group and thoracoscopic group were superiorrr to that in the dilation group(all P<0.05).The medium-term reponse rates in the three groups and the long-term reponse rate in the thoracoscopic group reached to 100% and the long-term reponse rate in thoracotomy group reached to 97.73%,the long-term reponse rate in dilation group reached to 86.96%.The symptoms of 3 relapsed patients were relieved after second dilation treatment.No esophageal bleeding,perforation and other serious complications occurred.Conclusion Endoscopic balloon dilation,Heller thoracoscopic surgery and open heart surgery Heller have good long-and mid-term efficacies for cardia achalasia.Balloon dilation is a simple and effective,low-cost,less trauma measure for cardia achalasia and should be considered first.Surgical treatment is the most effective way,but not as the preferred method.