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使用特制气囊行气体加压扩张术治疗贲门失弛缓症已日趋广泛应用,并取得了良好疗效。我们通过内镜直视下食管下段扩约肌气囊扩张术治疗了38例症状性贲门失弛缓症患者,勿需X线透视。使用改良Gruntizig型气囊(微孔30mm)在贲门部加压扩张成功地治疗了38例晚期失弛缓症。其中男性11例,女性27例,年龄13~52岁。每例患者扩张3~5次。38例共行137次扩张。平均每例3.6次。充气压15~ 相似文献
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目的探讨内镜下气囊扩张治疗失贲门弛缓症的术后护理进展。方法对32例贲门失弛缓症病人行术前、术中,特别是术后精心护理。结果 32例患者应用气囊扩张治疗贲门失弛缓症1~3次后成功率100%,无术后护理并发症发生。结论内镜下气囊扩张治疗失弛缓症方法安全有效,为患者延长寿命,术后正确的饮食指导,休息及严密观察并发症是治疗获得成功的关键。 相似文献
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内镜下气囊扩张治疗贲门失弛缓症的价值 总被引:1,自引:0,他引:1
贲门失弛缓症是一种病因不明的食管动力学功能障碍性疾病,表现为食管下括约肌的静息压明显高于正常,吞咽时不能充分松弛,严重影响食管排空,目前治疗尚无理想的方案,主要以外科手术及内镜下扩张为主,本文旨在探讨内镜下气囊扩张术治疗贲门失弛缓症的价值.
一、对象:选择1997年8月~1999年12月我院消化专家门诊诊断,并经胃镜钡餐及食管测压,证实贲门失弛缓症39例,男24例,女15例.男女之比1.6:1,年龄18~70岁,平均40.05±10.1岁,随机分组.内镜组20例行内镜下气囊扩张术,外科组19例行Heller手术治疗. 相似文献
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目的 评价贲门失弛缓症在胃镜下气囊扩张术的临床疗效及可能出现的并发症。方法 对21例贲门失弛缓症患者术前行X线食道吞钡,常规胃镜检查,并都确诊为功能性贲门失弛缓症。术前流质饮食1天,禁食12小时以上,给予适量的镇静剂(安定针)、咽部麻醉。由胃镜活检孔插入导丝,退出胃镜,沿导丝将涂有甘油的球囊。(为低顺应性聚乙烯囊),送入过贲门口处于气囊的中央部。由助手向囊内注气,使囊内压逐渐达到10—15psi,维持1—2分钟,间隔2—3分钟后再扩张,共2—3次;退出胃镜和球囊,再插入胃镜观察扩张出血情况及有无穿孔。并与外科肌切开术作比较,从而得出何者更具优点。结果 21例患者中,其中一例因球囊直径选择过小(14mm)而疗效欠佳行第2次扩张后临床症状消失外,其余5例一次既近期临床症状均消失。所有病例术中轻度恶心和胸痛,术后第1—2天轻度胸痛外,余无不适,术中及术后无并发症发生。扩张治疗与外科肌切开术均是有效缓解贲门失弛缓症症状的主要方法,但外科肌切开术组织创伤大,病人痛苦重,经费开支大,术后胃食管反流等不足之处。结论 贲门失弛缓症胃镜下气囊扩张术优于外科肌切开术。 相似文献
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目的 探讨内镜下气囊扩张术治疗食管贲门失弛缓症近期和远期临床疗效。方法 选择贲门失弛缓症病人12例为研究对象,进行气囊扩张。术后1周内行X线钡餐检查,术后半年内每月随访1次,以后每3个月随访检查1次。结果 所有病人在术后吞咽困难症状均有明显缓解。随访结果表明,在3、6、12个月随访期内,症状缓解率依次为91.7%(11/12),90%(9/10)、83.3%(56)。随着术后时间延长,症状缓解率呈逐渐下降的趋势。本组病人扩张术后虽然有局部粘膜撕裂、渗血等并发症,皆可自行缓解,未发生上消化道大出血、食管穿孔等严重并发症。结论 内镜下气囊扩张治疗食管贲门失弛缓症具有较好的疗效,且操作较简单,损伤小,恢复快,比较安全。 相似文献
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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 总被引:7,自引:1,他引:6
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。 相似文献
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气囊扩张术治疗食管贲门失弛缓症105例临床分析 总被引:1,自引:0,他引:1
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。 相似文献
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我们应用Microvasive生产的Rigiflex气囊导管扩张治疗器在内镜直视下扩张治疗贲门失弛缓症14例,取得了良好的疗效,现总结如下。1 对象与方法1.1 对象:贲门失弛缓症患者14例,男8例,女6例,年龄19~21(平均39.3)岁,病程4个月~8年,平均3.86年。按贲门失弛缓症诊断标准[1],本组均 相似文献
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Rajiv Mehta Anil John Shine Sadasivan C P Mustafa R Nandkumar V V Raj V Balakrishnan 《Indian journal of gastroenterology》2005,24(6):243-245
BACKGROUND: Pneumatic balloon dilation is a popular method of treating patients with achalasia cardia. It may be useful to know the factors that predict response to this treatment. AIM: To determine predictors of outcome following pneumatic balloon dilation in patients with achalasia cardia. METHODS: Records of 62 patients who had undergone pneumatic dilation using Rigiflex balloon dilators (Boston Scientific, Boston, MA, USA) were reviewed. Follow-up data were available for 52 patients. Data from patients with and without improvement in symptoms were compared. RESULTS: Of the 52 patients (age mean 44 [range 11-68] years; 27 male; median symptom duration 20 [4-90] months], 42 (81%) patients had response in symptoms after balloon dilatation. On univariate analysis, the responders more often had age> 40 years (26/42 [62%] versus 1/10 [10%], p=0.003), and less often had lower esophageal sphincter pressure> 50 mmHg (8/10 [80%] versus 10/42 [24%], p=0.0007) and mid-esophageal body hypocontraction (7/10 [70%] versus 12/24 [29%] p=0.01) than the non-responders. On multivariate analysis only age 相似文献
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目的 系统评价内镜下注射肉毒毒素与气囊扩张治疗贲门失弛缓症的有效性和安全性.方法 应用国际Cochrane协作网系统评价方法进行评价.结果 共纳人12个试验包括559例患者.Meta分析显示:(1)短期总有效率内镜下气囊扩张治疗优于内镜下注射肉毒毒素治疗(83.21%比71.27%,P<0.01).(2)长期总有效率内镜下气囊扩张治疗优于内镜下注射肉毒毒素治疗(54.59%比27.60%,P<0.01).(3)临床复发率内镜下注射肉毒毒素治疗高于内镜下气囊扩张治疗(55.66%比18.84%,P<0.01).(4)副作用及并发症发生率内镜下气囊扩张治疗高于内镜下注射肉毒毒素治疗(13.01%比1.35%,P<0.01).结论 目前的证据表明:内镜下注射肉毒毒素与气囊扩张均有较好的短期疗效和安全性,内镜下气囊扩张治疗在长期疗效上更优于内镜下注射肉毒毒素. 相似文献
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目的 评价胃镜下用Rigiflex气囊扩张器治疗原发性贲门失弛缓症的近期及远期疗效.方法 经临床症状、食管钡餐、食管测压和胃镜检查确诊的125例贲门失弛缓症患者在胃镜下用直径为3.5 cm的Rigiflex气囊扩张器进行扩张,术后根据临床症状积分、食管体正常蠕动率(EPR)、下食管括约肌静息压(LESBP)、下食管括约肌松弛率(LESRR)、下食管括约肌松弛度(LESRD)、食管钡餐和胃镜进行术后1月、6月、1年、3年和5年的随访.结果 治疗后1月内所有患者临床症状积分、LESBP、食管钡餐和胃镜均显著改善(P<0.01),EPR、LESRR和LESRD均无显著改善(P>0.05),5年随访中有7例复发,有效率达92.14%.治疗中1例出现食管穿孔.结论 在胃镜下用直径3.5 cm的Rigiflex气囊扩张器治疗原发性贲门失弛缓症是非常有效的方法,疗效较持久.随访中间歇性出现的临床症状可能与失调的食管蠕动和LES的松弛有密切关系. 相似文献
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B McJunkin W O McMillan H E Duncan K M Harman J J White J E McJunkin 《Gastrointestinal endoscopy》1991,37(1):18-21
In a retrospective study, 33 achalasia patients were treated with dilation therapy using large diameter mercury bougienage (mean, 56 French) and/or pneumatic balloon dilation. Mean follow-up time was 35 months. Mercury bougienage, performed in 20 patients, was successful in 10 (50%) with no complications. Pneumatic dilation was performed as initial therapy or in those having failed previous pharmacologic therapy and/or bougienage. A successful response was achieved in 19 of 23 patients (83%), with a 3.2% complication rate. In addition, in four patients with eventual recurrence of symptoms after initial pneumatic dilation, bougienage was used as a successful alternative to repeat pneumatic treatment. The combined efficacy of both forms of dilation was 88% with a complication rate of 1.4%. These data indicate that mercury bougienage should be considered initial therapy for achalasia in view of its simplicity, safety, and acceptable efficacy, followed by pneumatic dilation if bougienage is unsuccessful. Bougienage also may be considered if eventual recurrent symptoms develop after initially successful pneumatic dilation. Surgery should be utilized only if dilation therapy fails to achieve a satisfactory response. 相似文献
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Arnon Lambroza M.D. Robert W. Schuman M.D. 《The American journal of gastroenterology》1995,90(8):1226-1229
Objectives: To describe the technique of pneumatic dilation for achalasia without fluoroscopic guidance and to assess its safety and efficacy. Methods: Twenty-seven consecutive patients who underwent pneumatic dilation with the Rigiflex achalasia balloon under direct endoscopic visnalization were reviewed. The balloon was passed into the stomach over a guidewire, withdrawn across the gastroesophageal junction, and dilated with the endoscope positioned proximally. Patients wore graded pre- and posttreatment on the frequency of dysphagia, daytime regurgitation, nighttime symptoms, chest pain, and heartburn. Response was assessed by the Improvement in dysphagia frequency. Results: Twenty-seven patients (16 females, 11 males; mean age 54.0 yr) underwent 30 pneumatic dilations. The 30-mm balloon was used in most cases (67%). The mean postdilation follow-up was 21.1 months (1.5–57.4 months). The range of inflation pressures was 8–18 psi (median 15 psi), and the duration of inflation was 30–120 s (median 90 s). Eighteen of 27 patients (67%) had excellent or good results, six (22%) had fair results, and three (11%) had poor results. The outcome of pneumatic dilation was successful in 78% of patients after a single dilation and in 89% of patients overall. There were no perforations related to balloon inflation. Conclusions: The Rigiflex balloon can be successfully positioned across the gastroesophageal junction and dilated under direct endoscopic observation. Pneumatic dilation for achalasia can therefore be performed simply, safely, and effectively without the use of fluoroscopy. 相似文献
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Karamanolis G Sgouros S Karatzias G Papadopoulou E Vasiliadis K Stefanidis G Mantides A 《The American journal of gastroenterology》2005,100(2):270-274
OBJECTIVE: Achalasia is a well-defined esophageal motor disorder for which pneumatic dilation is an established therapeutic method. Even though it has been used for several years, there are limited data on the long-term outcomes of patients treated with this procedure. Hence, we aimed to evaluate the long-term efficacy of pneumatic dilation to control the symptoms of achalasia. METHODS: The medical records of all patients treated in our unit for achalasia with pneumatic dilation were reviewed. We identified the long-term result of the initial procedure, the date of the first dilation, and the time interval between dilation and retreatment. RESULTS: Of 260 patients who were treated with pneumatic dilation, 153 (67 men, 86 women) were followed up for more than 5 yr. The mean follow-up period was 11.09 +/- 3.91 yr, and the success rate of the dilation was 75.8%. Among these patients, 35 (19 men, 16 women) had follow-up periods of more than 15 yr. The mean follow-up time of those patients was 16.56 +/- 1.09 yr, and the success rate was 51.4%. Kaplan-Meier survival analysis showed that, overall, 50% of patients develop recurring symptoms after 10.92 yr. CONCLUSIONS: Although 51.4% of patients continued to be in clinical remission more than 15 yr after the initial pneumatic dilation, the long-term success rate of pneumatic dilation seems to drop progressively with time. 相似文献
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Di Giorgio P De Luca L Rivellini G Sorrentino E D'amore E De Luca B 《Gastrointestinal endoscopy》2004,60(3):347-350
BACKGROUND: Benign strictures arise in 5.8% to 20% of colorectal anastomoses. For such strictures, endoscopic dilation has proven to be a valid and safe treatment. A variety of endoscopic techniques have been proposed, but controlled prospective trials are lacking. This study compared dilation of this colorectal anastomotic stricture with an over-the-wire balloon designed for treatment of achalasia and with a through-the-scope balloon. METHODS: Thirty patients with symptoms caused by benign colorectal anastomotic stricture were randomly allocated to two treatment groups: 15 underwent dilation with a through-the-scope balloon and 15 had dilation with an over-the-wire balloon. Success was defined as an anastomotic lumen wide enough to allow passage of a standard 13-mm-diameter colonoscope, with resolution of symptoms. The success of dilation, the number of sessions required, the complications, and the duration of the dilation were recorded. Patients were followed for 24 months. RESULTS: Dilation was successful in all patients, with no procedure-related complication. The mean number of sessions required was 2.6 (0.98) in the through-the-scope group and 1.6 (0.77) in the over-the-wire group ( p = 0.009). The duration of response in days was greater in the over-the-wire group vs. the through-the-scope group, 560.8 (248.5) days vs. 294.2 (149.3) days, respectively, p = 0.016. CONCLUSIONS: Through-the-scope and over-the-wire dilation techniques are both effective and safe for treatment of benign colorectal anastomotic strictures. Using a greater diameter over-the-wire pneumatic balloon reduces the number of dilation sessions required and provides a longer-lasting response to dilation. 相似文献
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K Siedentopf E Schwenke 《Zeitschrift für die gesamte innere Medizin und ihre Grenzgebiete》1985,40(4):99-101
The results of the pneumatic cardia dilation in 17 patients are reported, which were yielded by means of a cardia dilation performed in doses. In this case an anaesthesia could be renounced. The pneumatic dilation performed in such a way proved as a risk-poor and effective method which loads the patient only insignificantly, is easily to be performed and has a large range of indication. 相似文献
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Treatment of Achalasia: The Best of Both Worlds 总被引:10,自引:0,他引:10
S. Abid M.D. G. Champion M.D. J.K. Richter M.D. R. McKivein M.D. R.L. Slaughter M.D. R.E. Koehler M.D 《The American journal of gastroenterology》1994,89(7):979-985
Objective: To conduct a retrospective analysis of one center's experience with treating achalasia over 4 yr with skilled gastroenterologists using primarily the Rigiflex halloon dilator and with a senior surgeon performing Heller myotomies. Methods: Newly diagnosed cases of achalasia were identified hy a computer search of hospital records. Charts were reviewed for the presence/ severity of dysphagia, regurgitation, heartburn, and chest pain. Weight loss was also recorded. Esophageal manometries and barium swallows were reviewed. Choice of treatment was made freely by patients. With an a priori definition of success, follow-up was conducted by telephone interviews. Results: A total of 45 achalasia patients (mean age, 46 yr; 32 females, 13 males) were identified with a symptoms-frequency as follows: dysphagia, 100%; regurgitation, 78%; heartburn, 50%; and chest pain, 42%. Mean weight loss was 17.5 pounds. Primary treatment was pneumatic dilation in 36 patients and surgery in nine patients. In a total of 45 pneumatic dilations, three (6.6%) were complicated by perforation. Five (14%) patients required repeat dilation. Mean duration of follow-up for pneumatic dilation and surgery was 27 months and 20.8 months, respectively. The overall excellent-good success rates were: pneumatic dilation 88% and surgery 89%. In comparing the efficacy of pneumatic dilation versus surgery, all symptoms were improved significantly ( p < 0.01) in both groups, except heartburn, which increased postmyotomy. Conclusions: If both procedures are available by skilled operators, pneumatic dilation and surgery are equally effective in the treatment of achalasia. 相似文献