气囊扩张治疗贲门失弛缓症

气囊扩张治疗贲门失弛缓症张泰昌沙忠芬张丽萍贲门失弛缓症为食管运动功能障碍性疾病，症状顽固，一般保守治疗多难以奏效。我院应用气囊扩张疗法对其进行治疗，取得显著疗效，现报道如下。１．一般资料：１９９０年１１月～１９９５年３月收治的贲门失弛缓症５７例，全部...     

内镜直视下贲门失弛缓症的气囊扩张治疗

贲门失弛缓症为食管运动功能障碍性疾病，症状顽固，一般药物治疗多难以奏效，我院应用内镜直视下气囊扩张治疗，疗效显著。现报告如下。一、材料与方法１．一般资料：１９９４年１１月至２００１年３月收治的贲门失弛缓症２６例，男１４例，女１２例，年龄２１～８０岁，平均（３４．２±１１．３）岁，病史９个月～２１年，平均（６．５±７．４）年。既往治疗口服硝苯吡啶２１例，口服消心痛１３例，还有口服６５４－２、中药等方法治疗。２．症状：吞咽困难２６例，胸痛２１例，消瘦１９例，肺部感染２例。３．X线检查：２６例患者进行…     

内镜下气囊扩张治疗贲门失弛缓症

贲门失弛缓症 (Achalasia,AC)为食管运动功能障碍性疾病 ,症状顽固。近年来 ,我院采用内镜下引导及监控 Regiflex气囊扩张治疗 AC,取得了良好疗效 ,可供参考。1　材料与方法1.1　一般资料　 1999年 10月以来收治 AC患者 14例 ,男 12例 ,女 2例 ,年龄 19～ 60岁 ,平均 37.7岁。病史 4个月～ 10年 ,平均 5 .6年。其中萨氏扩张器扩张术后复发患者 1例。1.2　诊断标准　 14例患者均有不同程度的吞咽困难 ,食后呕吐及明显消瘦 13例 (93% ) ,返酸、嗳气 1例(7% ) ,胸痛及胸骨后不适 2例 (14% )。本组 14例均行 X线及内镜检查 ,根据临床表现结…     

气囊扩张术治疗食管贲门失弛缓症105例临床分析

目的：观察气囊扩张术治疗食管贲门失弛缓症的疗效。方法：华西医大附一院收治的食管贲门失弛缓症病人105例，其中男性56例(53%)，女性49例(47%)，平均年龄34．2岁。主要临床症状为吞咽困难，食物反流，胸痛及体重减轻等。通过临床表现，X线钡餐可明确诊断。气囊经胃镜下导丝置人，压力5～10 PSI，维持30～60s，间隔2～3min后再扩张共2～3次。结果：105例病人显效95例（90．3％)，有效10例(9．6％)，无效0例。术后无1例穿孔，其他并发症轻。复发后重复扩张仍有效，较肉毒杆菌毒素注射及Hellsr’s肌切开术有更多优越性。结论：气囊扩张术为治疗贲门失弛缓症的首选方法。     

贲门失弛缓症气囊扩张前后食管测压指标的变化

贲门失弛缓症病因未明 ,多数人认为是迷走神经及其背核和食管壁肌间神经丛神经节细胞变性乃至消失 ,使得食管体部缺少蠕动和下食管括约肌 (LES)松弛不全。我院自1996年起对 35例贲门失弛缓症患者进行了气囊扩张 ,术前常规进行食管测压 ,其中 17例进行Rigiflex气囊扩张后测压复查及随访。现将其食管动力改变情况分析如下。一、资料和方法1 分组 :(1)病例组 :共 35例贲门失弛缓症患者 ,男 2 0例 ,女 15例 ,平均年龄 (38± 2 7)岁 ,所有患者经内镜和食管钡餐确诊为贲门失弛缓症。 (2 )对照组 :共 30例 ,男 13例 ,女 17例 ,平均年龄 (39± 14 …     

贲门失弛缓症气囊扩张对食管动力近期和中期的影响

目的　探讨气囊扩张对贲门失弛缓症患者食管动力的影响及与扩张疗效的关系。方法　4 8例经临床、钡餐造影、内镜检查及食管测压确诊的贲门失弛缓症 ,采用上消化道动力监测系统。观察扩张前和扩张后 4周以及 12～ 2 4周时的症状计分、钡餐造影显示的食管最大宽度、下食管括约肌压力(LESP)、下食管括约肌松弛率 (LESRR)及食管体部收缩振幅。结果　①扩张后吞咽困难、胸痛和反食症状的计分以及食管的最大宽度均明显低于扩张前 (P <0 .0 5 )。②扩张后 4周、12～ 2 4周 4个方位的LESP明显降低 (P <0 .0 5 ) ,4个方位相应的LESRR扩张后较扩张前明显增加 (P <0 .0 5 )。③扩张前后LESP <2 .6 7kPa次数百分比分别为 4 5 .4 1% ,82 .4 8%和 85 .87% (与扩张前比P <0 .0 5 ) ,LESRR≥80 %的次数百分比分别占 6 .74 % ,5 5 .97%和 4 3.78% (与扩张前比P <0 .0 5 )。④ 4 8例患者中未发现食管体部恢复推进性蠕动波。食管体部收缩振幅扩张前 ,后均表现为无效收缩。结论　①气囊扩张治疗贲门失弛缓症近期、中期疗效较好 ,并有维持治疗作用。②气囊扩张不仅降低LESP且改善LESRR ,是气囊扩张缓解症状、减少食管扩张程度的重要病理生理改变的基础。提示是否再行扩张的食管动力指标除LESP外 ,还要考虑LESRR。     

贲门失弛缓症贲门扩张前后食管测压变化

贲门失弛缓症是一种原发性食管神经肌肉病变,以下食管括约肌(LES)松弛障碍、食管体部缺乏蠕动性收缩为特点的动力障碍性疾病。扩张疗法是主要治疗方法,从2 0 0 0年7月始,我们对1 0例贲门失弛缓症患者的扩张治疗效果进行了食管测压研究。一、资料和方法1 .对象:确诊为贲门失弛缓症的住院患者1 0例,其中男5例,女5例,年龄1 9～5 7岁;病程3～1 2 0个月,平均(39 8±37 5 )个月。2 .治疗方法:采用探条扩张法或气囊扩张法。扩张器分别为Wilson Cook公司的Savary探条和专用贲门失弛缓症扩张气囊。3.食管动力检查:扩张前1d及扩张结束后2d行食管测…     

肌切开术和气囊扩张治疗食管贲门失弛缓症的前瞻性研究

目的　比较手术和气囊扩张治疗食管贲门失弛缓症的疗效。方法　对 ４８ 例患者（手术１８ 例,气囊扩张 ３０ 例）进行了一年以上的随访观察,通过对临床症状, Ｘ 线钡餐食管造影,胃镜检查和食管２４ 小时连续ｐ Ｈ 监测等进行比较分析。结果　手术和气囊扩张治疗食管贲门失弛缓症在以上几个方面差异均无显著性。结论　手术和气囊扩张均是治疗食管贲门失弛缓症安全有效的方法。而气囊扩张由于其方法简单,不必住院,费用较低等更适合我国国情。     

贲门失弛缓症气囊扩张致食管穿孔一例

患者女，83岁。进食困难5年，胃镜检查确诊为贲门失弛缓症，多次于当地医院行探条扩张术。近10d吞咽困难加重，不能进全流食，靠补液维持生命。食管钡餐检查示：食管中上段高度扩张，下端及贲门部呈锥样狭窄。选用美国Microvasive 35mm扩张气囊欲行扩张术。内镜观察：食管中下段高度扩张，距门齿37～41cm段逐渐狭窄，尤以42cm（贲门部）为著。     

自制气囊扩张治疗贲门失弛缓症9例

本报道我院自1992年10月至1995年6月用自制气囊扩张治疗贲门失弛缓症9例。9例均为女性，年龄25～69岁。平均41岁。病程6月～11年。临床表现有吞咽困难、食物返流及胸骨后疼痛，不同程度的体重减轻及贫血。2例干咳、气急、发绀患长期按“肺感染”治疗，而延误其原发病的诊治。     

结缔组织疾病食管运动功能研究

目的：对结缔组织疾病患者进行食管运动功能,并对部分患者治疗前后的结果进行比较,以研究结缔组织疾病食管运动功能障碍的特点及其对治疗的反应。方法：结缔组织疾病患者29例（类风湿性关节炎7例,SLE8例,硬皮病7例,皮肌炎2例,SLE合并硬皮病2例,SLE合并皮肌炎3例）。其中食管症状组15例,非食管症状组14例。10例有食管症状的患者在确诊后进行激素或／免疫抑制剂的治疗（疗程3月）,治疗后3月再次重复食管测压。并与健康对照组29例进行各项指标的比较。结果：（1）结缔组织疾病患者食管测压结果：病例组远端食管蠕动压（PA）、传导时间（PD）、传导速度（PV）与健康组相比有显著性差异（P＜0．05,P＜0．01）。（2）食管症状组下食管括约肌压力（LESP）、松弛率（LESR）、PA、PD、PV与健康组和非食管症状组相比有显著性差异（P＜0．05）,P＜0．01）。（3）治疗后LESP、LESR、PA提高,以PA改变尤为明显。（4）治疗前后食管异常收缩波的百分比：治疗前同步收缩的百分比为21．4％,治疗后为1．1％（P＜0．001）。结论：本组结缔组织疾病出现食管运动功能障碍,有食管症状组较非食管症状组食管受累更为明显,治疗后随病情好转食管运动功能障碍得到改善。     

Through-the-Scope Balloon Dilation for Endoscopic Ultrasound Staging of Stenosing Esophageal Cancer

Dilation of malignant esophageal strictures often is required to complete staging by endoscopic ultrasound (EUS). This study was designed to determine the successful dilation rate (ability to complete staging) and complication rate of through-the-scope (TTS) balloon dilation for malignant esophageal strictures during EUS. We retrospectively reviewed EUS reports for all cases of primary esophageal cancer staged at five centers between January 2002 and October 2004. All dilations were performed with TTS balloons. Among 272 endoscopic ultrasounds, dilation was required in 77 (28%) and was successful in 73 cases (95%). There was one esophageal perforation after dilation (1.3%; 95% confidence interval (CI), 0.2–7) and one esophageal perforation after EUS without dilation (0.5%; 95% CI, 0.1–2.8; P=0.48 by two-sided Fisher exact test). There were no other major complications. TTS balloon dilation is highly successful in permitting complete staging of obstructing tumors. The rate of complications after dilation with a TTS balloon dilator is low and similar to the baseline rate of EUS in this setting. Institutions Participating in the Study: Boston University Medical Center, University of Virginia, Oregon Health and Sciences University, University of Chicago, Veterans Administration Healthcare System, Boston, Massachusetts.     

Factors Predicting Outcome of Balloon Dilatation in Achalasia

Background Balloon dilatation of the lower esophageal sphincter (LES) is one of the effective nonsurgical treatment options in the management of achalasia. We aimed to determine the long-term results of graded balloon dilatation and the factors predicting outcome. Patients Patients followed for more than 12 months between January 1995 to March 2005, without history of endoscopic or surgical therapy before the study, were included (n = 111, mean age 46.3 ± 16.9 years; follow-up period 46.3 [12–150] months). Patients were evaluated by barium swallow contrast studies, upper endoscopy, and esophageal manometry. Pneumatic dilatation was performed with the use of polyethylene balloon system. Patient outcome was evaluated according to manometric studies and Van Trappen staging as determined following face-to-face interviews with the patients. Results We determined clinical response rates of 98%, 85.7%, and 75% at months 24, 48, and 60. According to receiver-operating characteristics (ROC) analysis, age ≤37.5 years, LES pressure (LESP) ≥30.5 mmHg, LESP after first balloon dilatation ≥17.5 mmHg, and balloon number >2 were found to negatively affect treatment response. Young age and higher esophageal body pressure at admission were determined to be negative predictive factors (P = 0.038, relative risk (RR) 2.6, 95% confidence interval [CI] 1.05–6.4 and P = 0.05, RR 1.069, 95% CI 0.99–1.14, respectively). Conclusion Balloon dilatation is an effective treatment of achalasia. Young age, higher esophageal body pressure, and high LESP after first balloon dilatation are negative predictive factors. Patients with young age requiring more than two balloon dilatations are likely to be unresponsive to the treatment.     

Pneumatic Balloon Dilation Therapy Is as Effective as Esophagomyotomy for Achalasia

For many years different treatments have been used for achalasia. However, esophagomyotomy (ESM) and pneumatic balloon dilation (PBD) have been considered the treatments of choice. Despite new research, some controversies still exist. We compared patients who underwent open ESM (n=19) with those who underwent PBD (n=45). Data on age, gender, pre- and postprocedure symptoms, clinical manifestations at the time of research, clinical relief, type of surgery, and costs were collected via questionnaire. Open ESMs were performed by two expert surgeons, and PBDs were performed by one gastroenterologist. There was no significant difference in clinical symptoms and in patient satisfaction between the groups before and after the procedures except for chest pain. Clinical relief status (excellent, good, moderate, or poor) was comparable (26%, 42%, 15%, 15% for open ESM group and 40%, 20%, 24%, 15% for PBD group). Postprocedure complications were not significantly different between the two groups. Clinical rates of relapse for open ESM and PBD groups were 38.6% and 25%, respectively. There were no serious complications. There was no significant difference between the clinical outcomes of the two methods of achalasia treatment. Considering other important factors such as a shorter period of hospitalization, fewer sick days off, risk of general anesthesia, and cosmetic sequels, PBD is preferable for the majority of patients.     

食管测压在评估气囊扩张术治疗贲门失弛缓症疗效中的作用

背景：贲门失弛缓症是原发性食管运动功能障碍性疾病，气囊扩张术是目前治疗本病的主要方法之一。目的：探讨食管压力测定在评估气囊扩张术治疗贲门失弛缓症疗效中的作用。方法：予21例贲门失弛缓症患者内镜下气囊扩张术，治疗前后行食管压力检测，分析食管下括约肌（LES）和食管体部各参数的变化。结果：扩张后，21例患者的吞咽困难和反流症状消失。与扩张前相比，扩张后LES长度无显著差异，LES静息压和LES残余压显著降低（P〈0．01），LES松弛率显著升高（P〈0．05）。扩张后食管体部同步收缩波和吞咽蠕动波消失的发生率较扩张前无显著差异，继发性收缩波和食管体部静息压高于胃内静息压的发生率较扩张前显著降低（P〈0．01）。结论：气囊扩张术能显著提高LES松弛率，降低LES静息压、LES残余压、食管体部静息压和继发性蠕动波的发生率，迅速缓解患者症状。食管压力测定对评估气囊扩张术治疗贲门失弛缓症的疗效具有重要意义。     

纤支镜下球囊扩张治疗结核性支气管狭窄的研究

目的评价纤支镜下球囊扩张治疗结核性支气管狭窄的效果和安全性。方法回顾性分析25例纤支镜下行球囊扩张的结核性支气管狭窄患者,于术前和最后一次球囊扩张当天估计狭窄段的气道直径,密切随访,评价其长期和短期疗效。结果25例结核性支气管狭窄的患者分别接受球囊扩张2～7次,平均(3.2±1.5)次。经过球囊扩张后,狭窄段支气管管腔明显增大,由术前的(2.8±1.1mm)增加为术后的(6.7±2.3mm)(P<0.01),短期疗效达100%。所有患者术中均未发生严重并发症。经过2～36个月的随访,未发生狭窄段的再狭窄。11例出现肺不张的患者,球囊扩张后完全复张2例。结论纤支镜下球囊扩张治疗结核性支气管狭窄具有有效、安全和简便等优点。     

贲门失弛缓症动物模型的建立及其机制探讨

背景:贲门失弛缓症是一种常见的食管动力障碍性疾病,其病因不清,目前尚缺乏有效根治措施。目的:建立猫贲门失弛缓症动物模型并探讨其发生机制,为贲门失弛缓症的根治提供依据。方法:胃镜下将苄基-二甲基-十四烷基氯化铵(BAC)注射至猫食管下括约肌(LES)周围,对照组注射生理盐水,观察动物进食和体重的变化。第8周时行食管钡餐检查,计算食管钡剂潴留率;测定LES静息压力(LESBP)、松弛率和松弛度;观察不同药物对体内LESBP和体外LES肌环张力的影响以及肌环对电场刺激的反应。采用免疫组化染色分析一氧化氮合酶(NOS)阳性神经元在LES肌环中的分布。结果:第8周时,BAC处理组进食减少,体重显著减轻(-P<0.05),食管钡剂潴留率显著高于对照组(P<0.01),LESBP显著增高(P<0.05),LES松弛率和松弛度显著减低(P<0.05),L-精氨酸对LESBP无影响,但硝普钠可使LESBP显著降低(P<0.05);对照组LESBP无明显变化,L-精氨酸和硝普钠均可使LESBP显著降低(P<0.05)。两组体外LES肌环由乙酰胆碱和硝普钠引起的收缩和舒张反应无明显差别,L-精氨酸可使对照组肌环松弛,但不能使BAC处理组肌环松弛,电场刺激不能引起BAC处理组肌环松弛,但能引起收缩。免疫组化染色提示BAC处理组LES肌环肌间神经丛NOS阳性神经元缺失。结论:通过LES注射BAC成功建立了