气囊扩张治疗食管贲门失弛缓症38例临床观察

目的总结内镜直视下气囊扩张器治疗食管贲门失弛缓症的疗效。方法38例贲门失弛缓症患者行内镜直视下气囊扩张治疗,比较分析扩张前后临床症状、术后1个月及1年的吞咽困难改善情况。结果38例患者中36例术后吞咽困难症状迅速消失,2例稍有改善,随访1个月及1年的有效率分别为94%、75%,1年失访共4例,复发6例。11例接受食管测压者扩张4周后LES-P较扩张前有明显下降(P<0.01)。未见有出现气胸,穿孔,消化道大出血等并发症。结论气囊扩张术治疗贲门失驰缓症简便、安全、有效,成功率高,并发症少,是治疗贲门失弛缓症的首选方法。     

内镜引导下气囊扩张治疗贲门失弛缓症

目的探讨内镜引导下气囊扩张治疗贲门失弛缓症的疗效。方法回顾性分析笔者所在医院收治的64例贲门失弛缓症患者的临床资料。结果64例患者均一次性完成内镜下气囊扩张操作，成功率100％。治疗后逐一随访1个月后，患者吞咽困难、呕吐等症状全部消失。6个月后仅1例稍有吞咽困难，无1例复发。结论内镜引导下气囊扩张治疗贲门失弛缓症方法简单易行，疗效确切，值得临床推广。     

胃镜直视下气囊扩张治疗贲门失驰缓症

目的:探讨胃镜直视下气囊扩张治疗贲门失驰缓症的方法和疗效.方法:采用内镜直视下气囊扩张术.结果:10例贲门失驰缓症患者吞咽困难完全消失7例、改善3例,2例患者一个月后复发,再次接受气囊扩张,症状明显改善,无大出血和穿孔等严重并发症.结论:胃镜直视下气囊扩张治疗贲门扩张失驰缓症是安全有效的方法.     

气囊扩张治疗贲门失弛缓症后的食管运动功能探讨

目的探讨内镜下气囊扩张治疗贲门失弛缓症后的食管运动功能的情况。方法23例贲门失弛缓症患者术前经X线、内镜及食管测压检查确诊,行内镜下气囊扩张后观察临床表现,1个月后复查X线、内镜及食管测压。结果随访1~18个月,平均随访(13.0±1.5)个月,22例疗效满意,1例在扩张后3个月复发,再次扩张症状缓解。结论气囊扩张治疗贲门失弛缓症,方法简易、安全,且疗效确切,在内镜直视下进行,气囊放置部位适当,扩张后食管运动功能明显改善,但仍需要进一步随访。     

球囊扩张术治疗贲门失弛缓症

目的探讨经球囊扩张术诊治贲门失弛缓症的临床疗效。方法 2009年3月15日—2013年3月15日,我院接收30例贲门失弛缓症者,对30例贲门失弛缓症者经球囊扩张术诊治。于术前、术后1个月及术后3个月、术后6个月时,观察30例患者的吞咽困难症状、贲门开放直径、并发症及病状缓解状况。结果在30例贲门失弛缓症者中,诊治1次的有10例,诊治2次的有18例,诊治3次的有2例,每人平均诊治2次。和行球囊扩张之前的人均贲门开放直径相比,贲门开放直径在扩张后增宽。和扩张前的症状相比,扩张后（1、3个月及6个月）贲门失弛缓症者的吞咽困难状况改善明显,P〈0.05。在30例贲门失弛缓症者中,均无严重并发症。结论经球囊扩张术对贲门失弛缓症进行诊治,安全有效,无论近期疗效,还是远期疗效,都非常满意,值得医疗推广。     

内镜下球囊扩张术治疗贲门失弛缓症的近期与远期疗效观察

目的 观察内镜下球囊扩张术治疗贲门失弛缓症的近期与远期疗效分析。方法 将中山大学附属第三医院粤东医院2010年1～11月收治的以贲门失弛缓症为诊断的患者总计40例作为研究对象,根据治疗方案分组,其中8例接受内镜下球囊扩张术治疗为研究组,另32例接受保守治疗为对照组,治疗后随访1年。比较症状积分,近期、远期疗效。结果 治疗后两组患者的症状积分明显下降,且观察组各指标明显低于对照组（P<0.05）。治疗组近期疗效的显效率高于对照组（P<0.05）。随访1年治疗组的Eckardt评分及食管下括约肌压力均低于对照组（P<0.05）。结论 在贲门失弛缓症患者中,以内镜下球囊扩张术治疗,可改善症状,获得较好近、远期疗效。     

贲门失弛缓症内镜下治疗的探讨

目的 探讨内镜下治疗贲门失弛缓症的方法,并观察其疗效.方法 选取60例贲门失弛缓症患者,按随机数字表法分成单纯扩张组、单纯肉毒杆菌毒素注射组和扩张联合肉毒杆菌毒素注射组,每组20例,术后定期观察患者病情的缓解情况及并发症.结果 三组患者治疗后吞咽困难、胸痛、呕吐较前缓解,单纯扩张组有17例疗效明显,单纯肉毒杆菌毒素注射组有15例疗效明显,扩张联合肉毒杆菌毒素注射组20例疗效均显著.结论 内镜下扩张联合肉毒杆菌毒素注射治疗贲门失弛缓症疗效优于单纯扩张和单纯肉毒杆菌毒素注射治疗,值得在临床中推广.     

内镜下注射肉毒素治疗食管贲门失弛缓症临床观察

目的分析探讨内镜下注射肉毒素治疗贲门失弛缓症的临床疗效。方法 19例贲门失弛缓症患者采用内镜下肉毒素注射治疗。结果 19例患者好转14例,显效4例,无效1例。总有效率94.7℅。结论内镜下注射肉毒素治疗食管贲门失弛缓症操作简单、疗效确切,值得推广。     

内镜下注射肉毒杆菌毒素治疗贲门失弛缓症8例分析

目的探讨内镜下注射肉毒杆菌毒素治疗贲门失弛缓症的疗效.方法对1999年11月～2001年1月收治的8例贲门失弛缓症患者,内镜下在贲门狭窄部位用A型肉毒杆菌毒素做5点注射治疗,每点用量20U,总量100U,1个月后重复注射1次,同时行食管下段超声内镜检查,观察黏膜层及肌层厚度,周围有无异常低回声区.结果经注射治疗后,有7例临床症状缓解,有效率87.5%,随访5个月～1年余,症状均无复发,1例病人出现一过性胸痛,1例病人出现上腹部隐痛不适.结论内镜下注射肉毒杆菌毒素治疗贲门失弛缓症方法简便,疗效确切,并发症少,不失为治疗该病的一种好方法,尤其对年老伴有其他疾病不能耐受手术、扩张治疗的患者更适宜应用.     

内镜下放置覆膜食管支架治疗贲门失弛缓症的临床分析

目的研究内镜下放置覆膜食管支架治疗贲门失弛缓症的临床疗效。方法选择16例确诊为贲门失弛缓症者,在内镜下放置覆膜食管支架3个月后,将支架取出,然后于1、3、6、9、12、15、18个月后对患者密切随访,根据临床表现,进行疗效评估。结果所有患者在放置支架前均有不同程度的吞咽困难,进食后梗阻感,进食后呕吐、胸闷、胸痛等症状,放置覆膜食管支架后,10例患者症状马上缓解,6例患者出现胸骨后异物感,其中2例患者还感觉胸骨后疼痛,但在1周时间内症状均明显减轻,随访1例出现复发,予以球囊扩张后缓解,其余病例均未复发。结论内镜下放置覆膜食管支架治疗贲门失弛缓症在缓解患者症状、减少复发率方面存在优势,可能是一种更具有潜力的治疗手段。     

Pneumatic dilatation in esophageal achalasia. Report of 61 cases

To assess the interest of pneumatic dilatation in patients with achalasia. MATERIAL AND METHODS: The work has interested 61 patients with achalasia who underwent pneumatic dilatation using polyethylene balloon (Rigiflex) dilators. 74 sessions of dilatation were performed and 13 patients underwent 2 sessions of dilatation (21%). One patient presented un esophageal perforation requiring a surgical treatment. The outcome was good on 88.9% and 83.3% of the patients after respectively one and six months. These results illustrate the interest of pneumatic dilatation in achalasia, which have to be proposed in the first line of the treatment.     

Balloon dilatation of the prostate--should it have a place in the urologist's armamentarium?

Transurethral balloon dilatation of the prostate is a safe method of treating benign prostatic hyperplasia; it has been largely free of complications, and does not produce retrograde ejaculation. However doubts remain over its efficacy. We have performed balloon dilatation on 28 patients using balloons of diameter 30 mm (90F), and one year follow-up data is now available on 20 patients. Nine patients were satisfied with the outcome of treatment and reported reductions in their symptom score by a mean of 8.8 points. In addition, eight of these patients showed a reduction in their ultrasound residual volume by a mean volume of 75 ml. However urinary flow rate was only improved in four. Of the remaining 11 patients, two showed some initial improvement but then relapsed and nine derived no benefit from the procedure. We conclude that balloon dilatation may be of value in younger patients wishing to avoid or delay TURP, but is unlikely to achieve wider application.     

Primary cricopharyngeal achalasia and its dilatation with balloon catheter

The primary cricopharyngealis achalasia (PCA) is a very uncommon functional disorder of the upper oesophageal sphincter (UES) characterized by dysphagia, frequent aspiration, and impaired relaxation of the UES. It should be differentiated from diseases of neuromuscular and ENT origin, from organic causes and other types of cricopharyngeal dysfunction. On suspected oesophageal inlet stenosis, swallow x-ray studies using water-soluble contrast material is performed, followed by oesophagoscopy. If the endoscope cannot pass into the oesophagus, balloon dilatation is performed to reach a diameter of 12-15 mm. This facilitates the passing of the endoscope and helps ruling out organic causes. If the stenotic segment dilates easily, the mucosa is intact, and no mechanical obstruction is discovered, then UES manometry is performed to differentiate from other motility disorders. Extraluminal causes are excluded using endosonography and CT. If PCA is diagnosed, low-pressure (1-1.5 atm) balloon dilatation is continued under fluoroscopic control until a lumen diameter of 18-20 mm is obtained. Efficacy of dilatation is assured clinically as well as with endoscopical, barium swallow and manometric studies. Five out of 28 patients with pharyngo-oesophageal dysphagia were found to have PCA. Patients presented with severe dysphagia and a predisposition to aspiration. The radiographic examination demonstrated stenosis at the UES level, and aspiration. It was possible to introduce the endoscope into the oesophagus only two of the five patients before the dilatation. The manometry was not pathognomonic, its value did not achieve the expectations. In contrast with organic stenoses, UES dilated easily using balloon catheter. Thereafter, the endoscope passed smoothly through the UES in each of cases. Following progressive dilatation--with low pressure (1.5-2 atm) up to 20 mm in diameter-, superficial mucosal damage was observed in one patient only. Patients' complaints ceased after treatment, and the barium swallow showed normal passage. Redilatation was necessary only in one case after following 21 (7-33) months. The authors supposed that the gastrooesophageal reflux plays role in the pathogenesis of PCA. Balloon catheter dilatation is an important diagnostic and at the same time effective, first choice, minimal invasive therapeutic method in PCA.     

支气管镜下高频电灼联合球囊扩张治疗结核炎性气道狭窄

目的 探讨支气管镜下高频电灼联合球囊扩张治疗结核炎性气道狭窄的疗效和安全性.方法 根据内镜治疗方法的不同,将55例结核炎性气道狭窄患者分成球囊扩张组(球囊组,26例)和高频电灼联合球囊扩张组(联合组,29例).两组患者每周接受内镜治疗1次,观察气道狭窄治疗有效率、需要治疗的次数,结核菌转阴时间以及术中和术后并发症;并于治疗结束后3个月复查纤维支气管镜,观察两组气道再狭窄率.结果 球囊组、联合组再通有效率分别为69.2%(18/26)、89.7%(26/29),两组比较差异无统计学意义(P＞0.05),达到再通有效的治疗次数分别为(3.5±1.3)、(1.5±1.1)次,两组比较差异有统计学意义(P＜0.01),术后结核菌转阴时间分别为(23.3±3.6)、(13.2±2.3)d,两组比较差异有统计学意义(P＜0.01).两组术中出血、严重缺氧、心律失常及气胸等发生率比较差异无统计学意义(P＞0.05),术后3个月气管再狭窄率分别是33.3%(6/18)、7.7%(2/26),两组比较差异有统计学意义(P＜0.05).结论 支气管镜下高频电灼联合球囊扩张治疗结核炎性气道狭窄安全有效,并可减少介入治疗次数,缩短结核菌阴转时间,还有可能减少再狭窄率.

Abstract：

Objective To explore the efficacy and safety of the bronchoscopic high frequency electrocoagulation combined with balloon dilatation in treating tuberculosis inflammatory airway constriction. Methods According to the different methods of treatment, 55 patients with tuberculosis airway constriction were randomly divided into two groups, the balloon dilatation group (26 cases) and combination group (29 cases). The patients in balloon dilatation group underwent bronchoscopic balloon dilatation and the patients in combination group underwent bronchoscopic balloon dilatation combined with high frequency electrocoagulation. The patients of the two groups accepted endoscopic therapy once a week. Effective rate of recanalization for the narrow airway, frequency of effective treatment and the time of tuberculosis bacterium vanishing was recorded. Intraoperative and postoperative complications were also observed. Three months after the treatment, all patients accepted bronchoscopic to observe and assess the airway restenosis rate. Results After treatment, the effective rate in balloon dilatation group and combination group had no significant difference[69.2%(18/26) vs. 89.7% (26/29 )](P＞ 0.05 ),but frequency of effective treatment and time of tuberculosis bacterium vanishing had significant difference[(3.5 ±1.3) times vs. (1.5 ± 1.1) times, (23.3 ±3.6) d vs.(13.2 ±2.3) d](P<0.01). There was no significant difference on the intraoperative and postoperative complications between two groups (P＞0.05). The airway restenosis rate was 33.3%(6/18) in balloon dilatation group and 7.7%(2/26) in combination group after treatment for 3 months (P ＜0.05). Conclusions Combination of bronchoscopic balloon dilatation and high frequency electrocoagulation is an efficacy and safety way for the tuberculosis inflammatory airway stenosis. It can reduce the frequency of interventional therapy, shorten the time of tuberculosis bacterium vanishing, and may also decrease the airway restenosis rate.     

气囊扩张治疗贲门失弛缓的临床研究

目的探讨气囊扩张治疗贲门失弛缓的疗效。方法选择2010年2月—2012年2月期间该院收治的贲门失弛缓患者43例,给予3.2cm的气囊扩张,共进行58次治疗,观察对比治疗前后的症状评分及钡餐检查后1min及5min的存钡宽度及高度,以此评价治疗效果。结果本组43例患者于治疗前后主要症状评分均有显著下降,与治疗前相比,P<0.05。且通过气囊扩张的有效治疗,对食管钡剂排空起到显著的改善作用。治疗总有效率为76.74%。结论采取气囊扩张治疗贲门失驰,效果显著,可有效改善患者症状,提升患者生活质量。     

Comparison of pneumatic dilation with pneumatic dilation plus botulinum toxin for treatment of achalasia

Among the therapeutic options for achalasia are pneumatic dilatation (PD), an appropriate long-term therapy, and botulinum toxin injection (BT) that is a relatively short-term therapy. This study aimed to compare therapeutic effect of repetitive pneumatic dilation with a combined method (botulinum toxin injection and pneumatic dilation) in a group of achalasia patients who are low responder to two initial pneumatic dilations. Thirty-four patients with documented primary achalasia that had low response to two times PD (<50% decrease in symptom score and barium height at 5 minute in timed esophagogram after 3 month of late PD) were randomized to receive pneumatic dilation (n=18) or botulinum toxin injection and pneumatic dilation by four weeks interval (n=16), PD and BT+PD groups respectively. Symptom scores were evaluated before and at 1, 6 and 12 months after treatment. Clinical remission was defined as a decrease in symptom score > or = 50% of baseline. There were no significant differences between the two groups in gender, age and achalasia type. Remission rate of patients in BT-PD group in comparison with PD group were 87.5% vs. 67.1% (P = 0.7), 87.5% vs. 61.1% (P = 0.59) and 87.5% vs. 55.5% (P = 0.53) at 1, 6 and 12 months respectively .There were no major complications in either group. The mean symptom score decreased by 62.71% in the BT-PD group (P < 0.002) and 50.77% in the PD group (P < 0.01) at the end of the first year. Despite a better response rate in BT+PD group, a difference was not statistically significant. A difference may be meaningful if a large numbers of patients are included in the study.     

Achalasia following gastro-oesophageal reflux.

Five patients initially presenting with symptomatic gastro-oesophageal reflux, proven by radiology or pH monitoring, subsequently developed achalasia, confirmed by radiology and manometry, after an interval of 2-10 years. During this period dysphagia, present as a mild and intermittent symptom accompanying the initial reflux in 3 of the 5, became severe and resulted in oesophageal stasis of food in all. Three of the 5 had a demonstrable hiatal hernia. In none was reflux a troublesome symptom after Rider-Moeller dilatation or cardiomyotomy undertaken for the achalasia. Gastro-oesophageal reflux does not protect against the subsequent development of achalasia. It is suggested that the autonomic damage eventually leading to achalasia may in its initial phases cause gastro-oesophageal reflux.     

头位分娩气囊扩张阴道术加笑气镇痛的临床观察

目的:探讨头位分娩时应用气囊扩张阴道术加笑气镇痛的有效性与安全性。方法:将120例单胎头位足月初产妇分为两组,在产程中用气囊扩张阴道术并同时吸入笑气(50%氧化亚氮与50%氧气的混合气体)实施分娩镇痛者60例(观察组);对照组60例,产程中间断吸入氧气,不用任何镇痛药物。观察两组产妇的产痛程度、产程时间、分娩方式、产后出血量、新生儿出生时Apgar评分及笑气吸入的副反应等。结果:气囊扩张术加笑气镇痛的产妇镇痛分级:0级14例,Ⅰ级42例,有效率为93.3%,与对照组比较,差异有显著性意义(P<0.05);观察组总产程时间为8.3h,第一产程为7.2h,第二产程为52.1min,明显短于对照组,具有显著性差异(P<0.05);观察组剖宫产率明显低于对照组,差异有显著性(P<0.05),阴道助产率、产后出血量及新生儿Apgar评分比较,两组无显著性差异(P>0.05)。结论:头位分娩时应用气囊扩张阴道术加笑气镇痛安全方便,易被产妇接受,可有效促进产程进展,缓解分娩疼痛,增加自然分娩率,降低剖宫产率,对母儿无不良影响。     

Balloon catheter dilatation of lower gastrointestinal tract stenoses: long-term results

AIM: Benign stenosis of the lower gastrointestinal tract usually develops, due to complication of a surgical intervention or sometimes because of other inflammatory bowel processes. Their reoperation is technically difficult and risky. Therefore the authors use a balloon catheter dilatation in the treatment of lower gastrointestinal tract stenosis since 1985. METHODS: First a guide wire is passed colonoscopically, then under X-ray control a double lumen balloon catheter, or directly through the channel of the endoscope a single or double lumen balloon catheter is introduced into the stenosis, which is then gradually dilated to 12-25 mm diameter. The applied pressure is 1.5-3 atm. Result of the dilatation can be judged from the decreased indentation of the balloon, and from increased diameter of stenosis at colonoscopic, or sometimes colonographic follow up. RESULTS: Between January of 1985 and July of 2001 they performed 123 dilatation on 52 patients. The causes of stenoses were in 40 cases postoperative stenosis, in 5 Crohn disease, in 2 ulcerative colitis, in 1 ischemic stenosis, and in 3 scar of the anus. From all stenosis cases 4 were localised to the anus, 40 to the rectum, 7 to the colon, and 1 to the terminal ileum. Due to the dilatation the average diameter of the stenosis was increased from 7.2 (1-14) mm to 19.7 (14-25) mm. Following the dilatation in 42 patients out of 52 the colonoscope was passed through the stenosis. Colostomies were closed in 11 cases out of 17. In 4 patients the subileus state ceased, and all of our 3 patients colo-cutan fistula healed rapidly. 16 out of 52 patients re-operation was proposed. One patient had fever as complication which was treated with antibiotics. CONCLUSIONS: Dilatation of benign stenosis of the lower gastrointestinal tract with balloon catheter is an effective method, which in most of the cases (69%) will stop the obstructive symptoms and in the long run therefore surgery can be avoided.