食管测压在贲门失弛缓症诊治中的应用及评价

目的　研究贲门失弛缓症患者的食管压力变化。方法　对 35例贲门失弛缓症患者与 30位正常对照的食管测压数据进行对比分析。结果　贲门失弛缓症组食管体部均为同步蠕动波 ,91 4 % (32 / 35 )为低幅同步收缩波 ;食管下括约肌松弛率 (LESRR)为 (6 9 1± 16 3) % ,明显低于正常对照的 (96 0± 0 1) % (P <0 0 1) ;食管下括约肌压增加 ;食管上括约肌各项指标与正常对照组比较无明显差别。结论　贲门失弛缓症的食管压力以低幅同步收缩波和LESRR增高为特征性表现。     

老年贲门失弛缓症诊治进展

<正>贲门失弛缓症(AC)是一种原发性食管动力障碍性疾病,典型的特征为下食管括约肌(LES)松弛障碍导致的食管流出道梗阻[1]。主要诊断方法包括钡餐透视、CT、内镜、高分辨率食管测压(HRM)等。随着HRM的广泛应用,其已成为诊断AC的金标准,在AC分型、指导手术方案的选择及疗效评估等方面发挥了重要的作用。但因为AC发病机制不明,难以从病因上得到治愈[2]。随着老年人群AC发病率升高,老年AC诊断的标准化及治疗方式的选择逐渐成为研究的热点     

我国贲门失弛缓症食管运动障碍的特征

目的了解我国贲门失弛缓症患者食管运动障碍的特征。方法调查了１４７例确诊为贲门失弛缓症患者的临床表现,并对其中１０２例进行食管压力测定。结果男女发病的比例为１∶１．２,发病年龄在２０～５０岁之间的占８５％。食管测压表现为：５６．９％患者ＬＥＳＰ在２０～４０ｍｍＨｇ（２．７～５．３ｋＰａ）之间,２２．５％的患者ＬＥＳＰ＜２０ｍｍＨｇ（２．７ｋＰａ）,ＬＥＳ松弛率与ＬＥＳＰ的高低无关（Ｐ＞０．１）;１０２例中有５６例出现较为完全的（ＬＥＳＲＲ＞７０％）ＬＥＳ松弛,包括吞咽后及非吞咽时出现的松弛,松弛的时限在４．８～１４．４秒之间,且松弛的时限与松弛率无关;食管体部的测压图形表现为低平型、强力型、中间型三种类型;ＵＥＳ未见异常。结论ＬＥＳＰ升高不是诊断贲门失弛缓症的必备条件;贲门失弛缓症可出现吞咽后或无吞咽时的ＬＥＳ松弛;食管体部波形不同的原因可能与支配ＬＥＳ的神经纤维受损程度不同有关。本研究为食管扩张治疗贲门失弛缓症提供了有用的信息。     

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…     

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 …     

肉毒碱注射治疗食管贲门失弛缓症

食管贲门失弛缓症 (achalasia)是一种原因不明的食管运动功能障碍性疾病,其主要特征是 :下食管括约肌 (LES)高压、食管缺乏蠕动和对吞咽动作的松弛反应障碍。临床表现为吞咽困难、食物反流以及下端胸骨后不适或疼痛,可伴有体重减轻等表现。本病的治疗主要是通过各种手段降低 LES压力。目前,括约肌切开术和气囊扩张被认为是标准的治疗方法,其不足是有可能并发胃食管反流、出血或食管穿孔;长效硝酸酯类、钙通道阻滞剂等药物尚难达到令人满意的临床效果。最近几年,一种新型的、有希望的治疗手段——食管下括约肌内注射肉毒碱应用于临…     

贲门失弛缓症的食管和食管外动力的研究

贲门失弛缓症的食管和食管外动力的研究蓝宇，柯美云１７世纪Ｔｈｏｍａｓｗｉｌｌｉｓ首次描述了贲门失弛缓症的食管动力异常。到目前为止，贲门失弛缓症的病因仍不十分清楚，但认为与食管壁内肌间神经丛（Ａｕｅｒｂａｃｈ’ｓ神经丛）的变性有关。有报告显示家族性的贲...     

贲门失弛缓症患者食管压力及运动功能变化的研究

目的研究贲门失弛缓症（achalasia cardia）患者食管下段括约肌（LES）压力及食道体部运动功能的变化。方法采用荷兰MMS多功能消化道测压仪，分别对48例贲门失弛缓症患者与30位正常人测量并记录LES长度、LES静息压力，10次湿咽动作中食道体部收缩及LES松弛功能变化，对LES、食管上括约肌（UES）松弛率和推进性蠕动进行评价。结果贲门失弛缓症患者与对照组相比，LES静息压力明显升高（P＜0．05），LES松弛率明显降低（P＜0．05）；贲门失弛缓症均为无传导性同步蠕动波；病例组与对照组食管体部蠕动波、LES长度、UES的各项指标比较差异均无统计学意义。结论LES压力升高、LES松弛率降低和食管体部运动功能失调是贲门失弛缓症患者的重要特征，对贲门失弛缓症的诊断有指导意义。     

贲门失弛缓症的内镜诊断探讨

经Ｘ线、食管测压和内镜确诊贲门失弛缓症５７例，突出症状为下咽困难、反流和胸痛。内镜主要表现为食管存有食物和液性滞留物、食管扩张、食管壁轮状收缩环、食管抻长和扭曲，还可见食管胃交接区紧闭，用内镜加压可以推开，反转观察贲门紧抱内镜轴。内镜检查不仅能对本病作出诊断，而且可以排除癌等其它器质性疾病和发现合并症。     

Intraoperative esophageal manometry in the surgical treatment of achalasia

Since 1985 we have done intraoperative manometry in 54 patients operated for achalasia. Manometry allows the assessment of the completeness of the division of the high pressure zone and ascertain the length of fundoplication (Nissen) as well as its pressure. In 26 patients pH and manometric controls were done postoperatively. Absence of reflux was noted in all and the pressure level after operation was 12.53 +/- 4.94 mmHg. Pressure measurements were not different from those of a group of 15 healthy subjects (15.2 +/- 2.45 mmHg). Dynamic studies of the high pressure zone revealed a post-deglutition relaxation of 72.5 +/- 16.32% over the basal tone. We believe that intraoperative manometry is essential in the surgical treatment of achalasia as it allows a precise control of myotomy as well as the fashioning of a high pressure zone to avoid reflux.     

高分辨率食管测压评估经口内镜下肌切开术治疗儿童贲门失弛缓症的临床研究

目的:探讨高分辨率食管测压(high resolution esophageal manometry,HREM)评估贲门失弛缓症(achalasia of cardia, AC)儿童经口内镜下肌切开术(peroral endoscopic myotomy, POEM)效果的作用。方法:收集2013年1月—2019年9月...     

经口内镜肌切开术对贲门失弛缓症患者食管动力的影响

目的探讨经口内镜肌切开术（POEM）对贲门失弛缓症患者食管动力的影响。方法对3例贲门失弛缓症患者POEM治疗前后的食管测压结果进行对比分析。结果术后3例患者食管下括约肌压力（LESP）和食管上括约肌残余压（UESRP）均低于术前,且差异有统计学意义（P〈0．05）;术后食管下括约肌残余压（LESRP）有2例明显降低至正常值,有1例变化不大,仍高于正常,平均值较术前降低但差异无统计学意义;术前3例患者均有食管蠕动波消失,术后食管蠕动波均无改善;3例患者术前食管下括约肌松弛率（LESRR）均低于正常值,术后仍均低于正常;食管上括约肌压（UESP）平均值术后较术前降低,但差异无统计学意义。结论POEM近期能明显改善贲门失弛缓症患者的食管动力学特征。     

贲门失弛缓症的非手术治疗方法

贲门失弛缓症是一种罕见的原发性食管运动障碍性疾病,其特征是食管下段括约肌弛缓不全,食物难以通过贲门,常伴食管近端扩张和失蠕动,临床常见症状为:吞咽困难、食物反流以及下段胸骨后不适或疼痛,可伴有体重减轻甚至营养不良,严重影响患者的生活质量。失弛缓症以外科手术尤其是腹腔镜治疗为主,开放式Heller肌切开治疗失弛缓症有效率可达80%,但创伤大,费用高,存在手术死亡及其他并发症,使多数患者不愿接受。此文结合近期的一些文献,总结贲门失迟缓症的非手术治疗方法,包括药物、A型肉毒毒素注射和气动扩张治疗,通过对各种方法的对比,为临床医生提供一些治疗选择。     

Endoscopic treatment of esophageal achalasia

Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry(HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometric type by HRM are also predictors of responsiveness to treatment. Older patients, females and type Ⅱ achalasia are better after treatment compared to younger patients, males and type Ⅲ achalasia. Self-expandable metallic stents are an alternative in patients non responding to conventional therapies.     

Non-surgical treatment of esophageal achalasia

INTRODUCTION Esophageal achalasia is a rare neuromuscular disorder characterized by degenerative changes of myenteric plexus leading to a selective loss of inhibitory nerve endings. The consequences of this damage are the irreversible loss of peristaltic …     

Medical treatment of esophageal achalasia

Calcium channel blockers have been previously shown to decrease lower esophageal sphincter (LES) pressure and improve symptoms in achalasia. We performed a placebocontrolled, double-blind, crossover study to assess the effects of oral nifedipine and verapamil on LES pressure, amplitude of esophageal body contraction, and clinical symptomatology in eight patients with symptomatic achalasia diagnosed by endoscopy, barium swallow, and manometry. Patients were randomized to receive up to 20 mg nifedipine, 160 mg verapamil, or placebo and underwent esophageal manometry before (baseline) and after four weeks on each drug. Diary cards were kept to record and grade symptoms and drug plasma level determinations were correlated with manometric and clinical findings. Both nifedipine and verapamil caused a statistically significant decrease in mean LES pressure, but only nifedipine caused a significant decrease in the amplitude of contractions of the smooth muscle portion of the esophagus. No statistically significant differences in the overall clinical symptomatology were noted with any of the drugs, although some individual improvements in dysphagia and chest pain were noted. We conclude that, despite the reduction in LES pressure and contraction amplitude of the distal esophageal body, oral nifedipine and verapamil do not significantly alter the clinical symptomatology of patients with achalasia.This work was presented in part at the 50th Annual Meeting of the American College of Gastroenterology, Miami Beach, Florida, October 1985, and published in abstract form in theAmerican Journal of Gastroenterology 80:833, 1985.