经口内镜下肌切开术治疗贲门失弛缓症的围术期护理

贲门失弛缓症( achalasia of cardia,AC)是一种原发性食管动力障碍性疾病,以食管下段括约肌( lower esophageal sphincter, LES)的松弛功能受损,食管蠕动波减少或消失,食管同步收缩为特征. 经口内镜下肌切开术( per-oral endoscopic myotomy, POEM)是目前贲门失弛缓症的主要治疗方式. 贲门失弛缓症患者的围术期护理对于POEM手术的成功具有重要意义,良好的围术期护理可以促进患者早日康复,提高患者的生活质量. 本文将对POEM治疗贲门失弛缓症的围术期护理作一综述.     

超声在食管失弛缓症诊断中的应用

目的：探讨超声在食管失弛缓症诊断中的价值。方法：用超声检查29例失弛缓症患者及30例正常人作为对照。结果：超声对失弛缓症的显示率和诊断符合率均为100％。失弛缓症的食管口径明显大于对照组（P＜0．01），其管壁较对照组增厚（P＜0．01）。所有患者的扩张食管内均有食管内容物潴留，食管蠕动消失。结论：超声对失弛缓症具有重要的诊断价值。     

贲门失弛缓症的超声显象诊断

对10例贲门失弛缓症进行了前瞻性超声显象研究,并观察到如下特征性超声显象表现:胃食管前庭扩张和液体潴留;对称性管壁增厚;饮水后贲门延迟开放或呈间歇性开放。本文材料提示超声显象能在贲门失弛缓症的临床处理中发挥重要作用。了解贲门失弛缓症的超声显象特征,可避免将贲门失弛缓症误诊为贲门癌。对X线上表现为光滑狭窄从而难以与贲门失弛缓症鉴别的浸润型贲门癌,超声显象有助于作出正确诊断。     

术中食管测压在外科治疗贲门失弛缓症中的应用

[目的]利用食管测压技术,监测贲门失弛缓症患者行改良Heller手术术前、术中、术后食管动力学的改变,探讨改良Heller手术的机制及疗效.[方法]对21例贲门失弛缓症患者行经腹改良Heller手术,对患者术前、术中、术后食管测压,术前、术后24 h pH值检测及术后并发症、远期疗效等进行观察.[结果]21例均手术顺利,无手术死亡,食管测压显示术后食管下括约肌压力（LESP）、吞咽后食管下括约肌松弛百分比等指标明显改善,术后随访19例,1例偶有进食不畅,优良率达94.7%.[结论]经腹改良Heller术在治疗贲门失弛缓症中机制合理,并发症少,疗效满意.附加抗反流术式是防止反流的有效措施.术中食管测压对提高手术疗效有一定的指导作用.     

食管下段癌误诊为贲门失弛缓症2例分析

贲门失弛缓症典型X线征象为食管下端呈“萝卜根”状或“鸟嘴”状狭窄,但单以食管下段“鸟嘴样”狭窄就诊断为贲门失弛缓症就大错特错了,我们在实际工作中,遇到2例食管下段狭窄呈鸟嘴状,均诊断为贲门失弛缓症,结果手术证实为食管贲门癌。现报道如下。     

可回收防反流支架治疗贲门失弛缓症的疗效观察

目的 探讨可回收防反流食管支架对贲门失弛缓症的治疗作用.方法 17例贲门失弛缓症患者,经胃镜置入可回收防反流食管支架后,观察症状、体征并进行胃镜检查及钡餐检查,观察贲门部通畅情况及有无胃食管反流,术后1～3个月回收支架.结果 17例患者支架置入成功,贲门部开通良好.放置1个月3例,2个月10例,3个月4例,均顺利取出.随访6～18个月,食管仍保持通畅.结论 可回收防反流食管支架治疗贲门失弛缓症具有操作简便、并发症少、回收方便、疗效确切等优点.     

可回收抗反流食管支架治疗贲门失弛缓症临床疗效观察

目的 探讨可回收抗反流食管支架对贲门失弛缓症的治疗作用.方法 24例贲门失弛缓症患者,经胃镜置入可回收抗反流支架,观察临床症状,进行胃镜及胃肠X线检查,了解贲门通畅和胃食管反流情况,并随访观察3～36个月.结果 所有患者支架置入一次成功,其中16.67%(4/24)患者在治疗期间支架移位,经过2～4次复位.分别在置入2～6周后,顺利取出支架.治疗后所有患者的吞咽困难均明显缓解.末出现严重不良反应及并发症.结论 可回收抗反流食管支架治疗贲门失弛缓症具有操作简易、疗效好、并发症少等优点,但其在食管内最佳放置时间的长期疗效有待进一步观察.     

LES功能状态对经腹超声评估食管静脉曲张的影响

目的 探讨食管下括约肌(LES)功能状态对经腹超声食管下段多普勒信号(LEDS)显示率的影响.方法 对内镜诊断为EV的34例患者及21例正常对照组,分别在静息状态及吞咽过程中采集食管下段彩色多普勒血流视频,对比分析2种状态下LEDS显示率,并与内镜结果对照分析.结果 经腹超声对EV组食管下段显示率可达88％,对正常组该显示率达95％.与LES静息状态相比,LES舒张状态能够显著提高经腹超声对LEDS显示率(87％ vs 67％,P＜0.05),并且能够提高LEDS分级.以LEDS分级达2级以上为截断值,其诊断中重度EV的敏感性及特异性分别为82％和85％.结论 LES舒张状态能够显著提高经腹超声对LEDS的显示率,LEDS分级与内镜下食管静脉曲张程度有一定相关性,为门静脉高压患者长期随访评估EV提供一种无创便捷的初步筛选方法.     

贲门失弛缓症在多层螺旋CT中的影像表现

目的总结食管贲门失弛缓症的多层螺旋CT影像学资料,提高对该病的临床诊断准确性,减少检查的重复性。方法对临床证实的食管贲门失弛缓症的17例患者的多层螺旋CT资料进行回顾性分析,总结其影像学特点。结果食管贲门失弛缓症有较为特征性的CT表现。结论根据贲门弛缓症多层螺旋CT的表现,结合X线、食管镜等检查,能对该病进行准确的诊断。     

肺癌压迫食管引起吞咽困难误诊为贲门失弛缓症

目的:认识肺癌压迫食管引起吞咽困难这一特殊病例的临床表现,提高该病的诊治水平.方法:对我院收治并误诊为贲门失弛缓症的1例肺癌的临床资料进行回顾性分析.结果:本例因间歇性吞咽困难、偶有呕吐、体重下降就诊,于某院经胃镜检查与上消化道造影诊断为贲门失弛缓症及慢性胃炎,后经我院CT及MRI诊断为左肺下叶中心型肺癌,侵犯纵隔(食管及主动脉),上消化道造影除外食管病变,结合病史及各种检查认为吞咽困难为肺癌压迫食管所致.结论:不重视患者的年龄因素、未对临床表现进行认真分析以及忽视相关的医技检查是本例误诊的主要原因.     

Sonographic findings in achalasia

PURPOSE: The aim of this study was to describe the sonographic features of achalasia. METHODS: Thirty-five patients with achalasia (17 men and 18 women; mean age, 43 years) were examined with transabdominal sonography, and the findings were compared with those in 41 volunteers without esophageal disease (21 men and 20 women; mean age, 41 years), 10 patients with gastroesophageal junction carcinoma (7 men and 3 women; mean age, 55 years), and 4 patients with peptic stricture (3 men and 1 woman; mean age, 39 years). The distal end of the esophagus was evaluated, and the thickness of the esophageal wall was measured. RESULTS: In 28 fasting patients (80%) with achalasia, sonography showed dilatation, retention of fluid, and smooth narrowing of the distal esophagus (like a bird's beak). These findings were not identified in the other patients or volunteers. In addition, in 6 of 7 achalasia patients who had no sign of esophageal dilatation in the fasting state, water retention was demonstrated after ingestion of water, bringing the total number of patients with achalasia with positive sonographic findings to 34 (97%). In patients with achalasia, the mean thickness (+/- standard deviation) of the esophageal wall at the gastroesophageal junction was 4.8 +/- 0.9 mm (range, 3.6-7.2 mm). The thickening was regular, symmetric, and localized to the gastroesophageal junction. In the volunteers, the mean thickness of the esophageal wall was 2.3 +/- 0.5 mm (range, 1.4-3.5 mm). The difference between the 2 groups was statistically significant (p < 0.001). In the patients with carcinoma, the mean wall thickness was 17.0 /+ 1.1 mm, and the thickening was irregular. In the patients with peptic stricture, the mean wall thickness was 5.1 +/- 1.1 mm (range, 3.8-8.3 mm), and the thickening was irregular and occupied a longer segment of the distal esophagus. CONCLUSIONS: In patients with achalasia, transabdominal sonography clearly shows the regular thickening of the esophageal wall, water retention, dilatation of the distal esophagus, and the bird's beak appearance. Sonography may help in differentiating achalasia from carcinoma and peptic stricture of the gastroesophageal junction, which is difficult to do with other modalities.     

贲门失弛缓症的动力研究和胃镜直视下气囊扩张治疗

目的 :研究贲门失弛缓症患者扩张治疗前后食管动力学特征及气囊扩张治疗贲门失弛缓症的可行性。方法 :35例患者 ,均在非透视胃镜直视引导下行扩张治疗。其中 17例扩张治疗前、治疗后 3d以内、治疗后 3月、10例治疗后 1年行食管测压 ,观察下食管括约肌压力 (LESP)、松弛率 (LESR)及食管体部蠕动收缩的压力波幅和时限。结果 :35例患者扩张治疗全部有效。扩张后从症状积分看出 ,扩张后患者的临床症状明显改善 ,且持续一年 (P <0 .0 0 1)。扩张治疗后LESP ,LESR明显改善 ,以LESP下降尤为明显。结论 :气囊扩张法治疗贲门失弛缓症的近远期疗效均好 ,气囊扩张治疗疗效肯定 ,应予推荐。     

空腹超声诊断贲门及腹段食管肿瘤

目的：本文旨在探讨空腹状态下经腹超声检测腹段食管及贲门部肿瘤的诊断价值。材料和方法：本院病人２２０例,禁食水１０小时以上,经肝窗顺次扫查腹段食管及胃贲门,观察声像图特征及周围淋巴结情况,超声显像与胃镜和手术结果进行盲法对照分析。结果：超声检测腹段食管和贲门结构显示率为９８％,超声诊断的敏感性、特异性和准确度分别为腹段食管癌９１．７％、９８．４％、９８％,贲门癌９５．７％、９７．９％、９７．６％,对     

超声诊断贲门病变的临床应用

目的：探讨常规经腹超声检测贲门病变的诊断价值。方法：常规超声经肝窗探查患者胃贲门部,观察声像图特征及周围淋巴结情况,超声显像与胃镜和手术结果对照分析。结果：超声检测贲门显示率为９６％,正常组、良性病变组、贲门癌组的贲门壁厚度分别为４．０±０．２５ｍｍ、７．６±４．３ｍｍ、１７．２±５．６ｍｍ,各组间均存在显著差异（Ｐ＜０．００１）,以贲门壁厚度９ｍｍ为截断点,超声诊断贲门癌的敏感性、特异性、准确度均为９８％。对伴随淋巴结转移的诊断符合率为８１％。结论：超声诊断贲门部病变,可作为胃镜和Ｘ线钡餐造影的有效补充,对临床决策具有重要价值。     

Pathogenesis,clinical manifestations,diagnosis, and treatment progress of achalasia of cardia

Achalasia cardia, type of esophageal dynamic disorder, is a relatively rare primary motor esophageal disease characterized by the functional loss of plexus ganglion cells in the distal esophagus and lower esophageal sphincter. Loss of function of the distal and lower esophageal sphincter ganglion cells is the main cause of achalasia cardia, and is more likely to occur in the elderly. Histological changes in the esophageal mucosa are considered pathogenic; however, studies have found that inflammation and genetic changes at the molecular level may also cause achalasia cardia, resulting in dysphagia, reflux, aspiration, retrosternal pain, and weight loss. Currently, the treatment options for achalasia focus on reducing the resting pressure of the lower esophageal sphincter, helping to empty the esophagus and relieve symptoms. Treatment measures include botulinum toxin injection, inflatable dilation, stent insertion, and surgical myotomy (open or laparoscopic). Surgical procedures are often subject to controversy owing to concerns about safety and effectiveness, particularly in older patients. Herein, we review clinical epidemiological and experimental data to determine the prevalence, pathogenesis, clinical presentation, diagnostic criteria, and treatment options for achalasia to support its clinical management.     

多途径超声联合检查在先天性阴道闭锁诊断中的应用价值

目的分析先天性阴道闭锁超声影像学特征,探讨多途径超声联合检查在诊断及鉴别诊断先天性阴道闭锁中的临床应用价值。 方法回顾性分析2021年3月至2022年5月在深圳市罗湖区人民医院经手术证实的22例先天性阴道闭锁患者的临床资料,所有患者均行经腹部超声、经会阴超声、经直肠腔内超声和经直肠双平面高频超声联合检查,总结多途径超声联合检查诊断不同类型阴道闭锁的超声影像学特征,并与手术结果进行对比分析。 结果本组22例先天性阴道闭锁患者接受经腹腔镜下阴道成形术或经会阴闭锁阴道切开成形术,其中13例为Ⅰ型阴道闭锁,12例术前超声检查结果与手术结果一致,符合率为92.3%;9例为Ⅱ型阴道闭锁,术前超声检查结果均与手术结果一致,符合率为100%。13例Ⅰ型阴道闭锁患者行经腹部、经会阴和经直肠腔内超声检查均可见阴道中上段积血;经直肠双平面高频超声检查在阴道积血下方、膀胱尿道后壁与直肠前壁之间未见正常阴道结构显示,仅见中等回声的结缔组织间隙,为闭锁的阴道下段,闭锁阴道长度＜3 cm者4例,≥3 cm者9例。Ⅱ型阴道闭锁患者行经腹部、经会阴和经直肠腔内超声检查可见子宫颈发育异常,膀胱尿道后壁与直肠前壁之间的阴道走行区域未见积血;经直肠双平面高频超声检查在膀胱尿道后壁与直肠前壁之间未见正常阴道结构,仅见中等回声的结缔组织间隙,于尿道内口水平测量此间隙厚度为1.2~7.8（2.81±1.01）mm。术中诊断子宫内膜异位症的发生率为59.1%（13/22）,其中腹膜型子宫内膜异位症占比为92.3%（12/13）。 结论多途径超声联合检查能够准确诊断先天性阴道闭锁并分型,为临床个性化手术方式的选择提供可靠的影像学诊断依据。     

Endosonographic appearance of the esophagus in achalasia

Primary motility disorders of the esophagus require the exclusion of intramural tumors. The procedures currently used for the differential diagnosis of achalasia such as endoscopy with biopsy, esophageal and gastric radiography, abdomino-thoracic computed tomography and intraluminal esophageal manometry, are unsatisfactory when a tumor growing intramurally is suspected. A more recent method of studying the integrity of the gastrointestinal wall and its surrounding tissue is endoscopic ultrasonography. In 16 patients suspected of having achalasia, endosonography was performed in addition to the above-mentioned conventional examinations. Fifteen of them showed a normal ultrasonic structure of the wall of the gastro-esophageal junction, with no sign of hypertrophy of the smooth muscle layer. In the remaining case endoscopic ultrasonography was able to detect an intramural tumor, as evidenced by the inhomogeneous ultrasonic structure of the esophageal wall. Computed tomography and all the other conventional diagnostic procedures used failed to demonstrate this tumor. In conclusion, the findings presented strongly suggest that endosonography can contribute to the differential diagnosis of achalasia and intramural tumors.     

Transabdominal US staging of gastric cancer

Penetration of gastric cancer through the wall is important because the treatment modality and prognosis are accordingly different. A prospective study was performed to assess the value of transabdominal ultrasonography in the differentiation of early gastric cancer limited within the mucosa and submucosa from advanced cancer extending into the muscle layer. Fifteen patients with early gastric cancer and 29 patients with advanced gastric cancer were evaluated preoperatively and compared with histological findings. Patients were referred after endoscopy and sonologists were informed of the site of the gastric lesions. Patients ingested 600–800 ml of boiled water and transabdominal ultrasonography of the gastric lesion was accomplished using a commercially available ultrasound equipment with 5.0 and 3.5 MHz transducers. Using the intact middle hyperechoic layer on sonogram as the criterion for early cancer, 10 of 15 patients with early gastric cancer and 27 of 29 patients with advanced gastric cancer were correctly diagnosed (84%). Fourteen of 15 cases with early gastric cancer showed a thickness of the lesion below 1.0 cm, while seven of 29 cases with advanced cancer showed a thickness 1.0 cm or less. We believe that transabdominal sonography may be a valuable method in the differentiation between early and advanced gastric cancer.An editorial commentary on this article follows on pp. 532–536.     

经腹及经会阴超声对前置胎盘诊断价值比较

目的探讨经腹与经会阴超声技术对晚期妊娠前置胎盘的诊断价值。 方法对同一组患者先经腹超声检查子宫壁、胎儿、胎盘位置，测量胎盘下缘与宫内口的距离，发现可疑病例再经会阴进一步检查，比较两者的诊断价值。 结果85例B超追踪检查到结束妊娠，5例低置胎盘，3例边缘性前置胎盘，3例部分性前置胎盘，2例完全性前置胎盘。经腹超声对前置胎盘显示满意率为69．4％，经会阴超声对前置胎盘显示满意率为94％，经会阴超声检查的显示满意率明显高于经腹超声（P〈0．05）。 结论经会阴检查显示其独特的优越性，与经腹联合能提高显示满意率，且方法简便，易普及。