肌切开术和气囊扩张治疗食管贲门失驰缓症的前瞻性研究

目的 比较手术和气囊扩张治疗食管贲门失驰缓症的疗效。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,通过对症状,Ｘ线钡餐食管造影,胃镜检查和食管２４小时连续ｐＨ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驰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。     

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...     

贲门失弛缓症气囊扩张治疗前后食管运动功能的研究

目的：对１７例贲门失弛缓症患者扩张前后进行食管测压,研究贲门失弛缓症患者扩张治疗前后食管动力学特征及其与扩张疗效的关系。方法：贲门失弛缓症患者１７例,所有患者根据临床表现、钡餐、内镜和食管测压确诊,并在确诊后行气囊扩张。１７例扩张治疗前、治疗后３天以内及３月,１０例治疗后１年观察临床症状积分及测压指标。结果：（１）扩张后患者的下状明显改善,且持续１年（Ｐ〈０．０１）。（２）扩张后３天及３月ＬＥＳＰ     

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。     

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…     

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。     

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 …     

内镜引导下气囊扩张治疗贲门失弛缓症的研究

本文旨在评价内镜引导下气囊扩张对贲门失弛缓症的治疗价值。64例贲门失弛缓症病人接受气囊扩张治疗。扩张治疗前26人(40.6％)不能进某些固体食物,38人(59.3％)只能进半流质,1人(0.01％)只能进流质者。每周气囊扩张食管下段及贲门部一次,4次为一疗程。第一次气囊扩张治疗后,54人(84.4％)吞咽困难症状消失,第二次气囊扩后64人(100％)吞咽困难症状消失。本研究表明,内镜引导下气囊扩张法是治疗贲门失弛缓症的一种有效方法。     

经胃镜行气囊扩张术治疗贲门失弛缓症18例临床分析

目的探讨经胃镜行气囊扩张术治疗贲门失弛缓症的疗效。方法对18例贲门失弛缓症患者在胃镜直视下应用气囊扩张器行扩张术治疗,术后行胃镜或X线检查以评价疗效。结果 18例患者均获一次性扩张成功,扩张显效18例(100.0%),无效0例。无穿孔、大出血等并发症发生。结论经胃镜引导下行气囊扩张术是有效治疗贲门失弛缓症的非外科手术方法。     

Starting a peroral endoscopic myotomy program at your institution

Starting a peroral endoscopic myotomy (POEM) program can be difficult. There is no substitute for careful planning and execution. Support at every level is required to make a POEM program a reality. There are 5 essential components to start a POEM program: recruiting collaborators, proper clinical training, institutional support, institutional review board approval, and technical/engineering/nursing support. Without these key components, any endeavor to set up a POEM program is less likely to be successful. Having a collaborative, multidisciplinary team is important for success. Adequate preparation and training are a must. To that end, observation of live human cases and hands-on experience in the animal laboratory are essential prerequisites. Institutional support in terms of laboratory funding, protected time for research, billing and coding assistance, and endorsement of one's Credentialing Committee are also significant components of a successful program. At least initially, a POEM program should be executed under the oversight of one's institutional review board to legitimize the program for medicolegal purposes, and to help smooth the credentialing process. Finally, support from key personnel should be obtained. These include surgical and endoscopy nurses and technicians, recovery room and ward nurses, and also endoscopy and device representatives, all of whom can provide vital technical assistance when and where it is needed most.     

Peroral endoscopic myotomy: An emerging minimally invasive procedure for achalasia

Peroral endoscopic myotomy (POEM) is an emerging minimally invasive procedure for the treatment of achalasia. Due to the improvements in endoscopic technology and techniques, this procedure allows for submucosal tunneling to safely endoscopically create a myotomy across the hypertensive lower esophageal sphincter. In the hands of skilled operators and experienced centers, the most common complications of this procedure are related to insufflation and accumulation of gas in the chest and abdominal cavities with relatively low risks of devastating complications such as perforation or delayed bleeding. Several centers worldwide have demonstrated the feasibility of this procedure in not only early achalasia but also other indications such as redo myotomy, sigmoid esophagus and spastic esophagus. Short-term outcomes have showed great clinical efficacy comparable to laparoscopic Heller myotomy (LHM). Concerns related to postoperative gastroesophageal reflux remain, however several groups have demonstrated comparable clinical and objective measures of reflux to LHM. Although long-term outcomes are necessary to better understand durability of the procedure, POEM appears to be a promising new procedure.     

First splenic rupture following an endoscopic esophageal myotomy: A case report

BACKGROUND The occurrence of splenic rupture is extremely rare during an upper gastrointestinal endoscopy. Although infrequent, splenic rupture is a known complication secondary to colonoscopy. However, occurrence of splenic rupture after peroral endoscopic myotomy(POEM) has never been reported to date.CASE SUMMARY We describe a case of a splenic rupture following a POEM for recurrent achalasia in a patient who previously had a Heller myotomy. Splenic rupture remains very uncommon after an upper gastro-intestinal endoscopic procedure. The most plausible cause for this rare splenic injury appears to be the stretching of the gastro-splenic ligament during the endoscopy. A previous surgery may be a risk factor contributing to this complication.CONCLUSION The possibility for the occurrence of specific complications, such as splenic rupture, does exist even with the development of advanced endoscopic procedures, as presented in the present case after POEM.     

Achalasia of the oesophagus: Treatment with pneumatic dilatation

A series of 51 patients with achalasia of the oesophagus treated by pneumatic dilatation between 1980 and 1988 is reported. Treatment was assessed as effective (no or minimal dysphagia) in 78% of patients, followed for a mean of 30 months. Thirty-four patients required only one dilatation and only two patients had more than 3 dilatations. There were no deaths, but perforation occurred in seven patients, four of whom required early surgical repair. A further five patients were referred for elective surgery. Factors possibly contributing to oesophageal perforation are discussed.     

经皮二尖瓣球囊扩张术治疗老年人二尖瓣狭窄的临床观察

目的 探讨经皮二尖瓣球囊扩张术(PBMV)治疗老年人二尖瓣狭窄的疗效、安全性及并发症的预防.方法 采用改良的房间隔定位法及运用跨二尖瓣技术对老年二尖瓣狭窄患者行逐步球囊扩张.手术前后分别记录即刻左心房压、肺动脉平均压、二尖瓣跨瓣压差及二尖瓣口面积,并进行手术后随访.结果 PBMV有效扩大了二尖瓣口面积,与术前比较,术后左心房压下降[分别为(25.3±6.7)mm Hg(1 mm Hg=0.133 kPa)与(16.4±5.8)mm Hg]、二尖瓣跨瓣压下降[分别为(17.6±6.7)mm Hg与(6.8±2.9)mm Hg]、肺动脉压下降[分别为(38.6±12.1)mm Hg与(29.2±9.8)mm Hg],二尖瓣口面积增加[分别为(1.05±0.22)cm2与(1.61±0.38)cm2],心功能明显改善,差异均有统计学意义(P＜0.05或P＜0.01).随访结果表明,PBMV疗效稳定.结论 PBMV操作技术的改进能明显改善老年患者二尖瓣狭窄症状,显著降低手术的并发症.

Abstract：

Objective To evaluate the efficacy and safety of the improved percutaneous balloon mitral valvuloplasty (PBMV) in elderly patients with mitral stenosis. Methods Elderly patients with severe mitral stenosis received an improved PBMV which included a modified way of atrial septal puncture and technique across the mitral valve. The left atrial pressrue (LAP), mean pulmonary pressure (MPA), mean gradient across the mitral value (MPG) and mitral valve area (MVA) were recorded and compared before and after the operation. Long term follow up were made. Results After operation, the LAP decreased [(25.3±6.7) mm Hg vs.(16.4±5.8) mm Hg,1 mm Hg=0.133 Kpa], MPG decreased [(17.6±6.7) mm Hg vs.(6.8±2.9) mm Hg], MPA decreased [(38.6±12.1) mm Hg vs. (29.2±9.8) mm Hg], MVA increased [(1.05±0.22)cm2 vs.(1.61±0.38)cm2] and the New York heart association heart function classification improved. The follow-up result showed that the effect of PBMV was constant. Conclusions Improved PBMV may be an effective and safe measure for patients with mitral stenosis.     

Same site submucosal tunneling for a repeat per oral endoscopic myotomy: A safe and feasible option

Per oral endoscopic myotomy (POEM) is a novel endoscopic procedure for achalasia treatment. Due to its novelty and high success rates, a repeat procedure is usually not warranted, making the feasibility and safety of such approach unknown. We report the first case of a successful repeat POEM done at the same site of a previously uncompleted POEM. An 84-year-old female with type 2 achalasia presented for a POEM procedure. The procedure was aborted at the end of tunneling and before myotomy due to hypotension, which later resolved spontaneously. POEM was re-attempted at the same site of the original tunnel 1 year afterward, and surprisingly we didn’t encounter any submucosal fibrosis. The procedure felt similar to a native POEM and a myotomy was performed uneventfully. Our case is the first to suggest that submucosal tunneling during a repeat POEM can be done at the same site. Hypotension during POEM is a rare complication that should be recognized as a potential result of tension capnothorax, it can however, be managed with close supportive care.     

Long-term results of endoscopic balloon dilatation of lower gastrointestinal tract strictures in Crohn''s disease:A prospective study

AIM: To examine the long-term results of endoscopic treatment in a prospective study conducted over a period of 10 years, 1997 to January 2007.METHODS: A total of 25 patients (20 female and five male: aged 18-75 years), with at least one symptom of stricture not passable with the standard colonoscope and with a confirmed scarred Crohn's stricture of the lower gastrointestinal tract, were included in the study.The main symptom was abdominal pain. The endoscopic balloon dilatation was performed with an 18 mm balloon under endoscopic and radiological control.RESULTS: Eleven strictures were located in the colon, 13 at the anastomosis after ileocecal resection,three at the Bauhin valve and four in the ileum. Four patients had two strictures and one patient had three strictures. Of the 31 strictures, in 30 was balloon dilatation successful in a single endoscopic session, so that eventually the strictures could be passed easily with the standard colonoscope. In one patient with a long stricture of the ileum involving the Bauhin valve and an additional stricture of the ileum which were 15 cm apart, sufficient dilatation was not possible. This patient therefore required surgery. Improvement of abdominal symptoms was achieved in all cases which had technically successful balloon dilatation, although in one case perforation occurred after dilatation of a recurrent stricture. Available follow-up was in the range of 54-118 mo (mean of 81 mo). The relapse rate over this period was 46%, but 64% of relapsing strictures could be successfully dilated again. Only in four patients was surgery required during this follow-up period.CONCLUSION: We conclude from these initial results that endoscopic balloon dilatation, especially for short strictures in Crohn's disease, can be performed with reliable success. Perforation is a rare complication.It is our opinion that in the long-term, the relapse rate is probably higher than after surgery, but usually a second endoscopic treatment can be performed successfully, leading to a considerable success rate of the endoscopic procedure.