食管贲门肌层切开加食管胃底固定术治疗贲门失弛缓症

笔者对9例贲门失弛缓症患者行改良的Heller术式,把食管贲门肌层切开,加食管胃底固定。方法是:开胸,切开膈肌,游离贲门、胃底,探查证实诊断后,纵行切开食管左侧壁肌层,游离前半周,经胃管注气.使粘膜充分膨出,解除约束。将胃底上提,完全覆盖在食管切开之创面上,将胃浆膜与食管肌层间断缝合,常规关     

食管贲门失弛缓症的中医治疗

食管贲门失弛缓症是一种以食管的原发性功能几乎完全丧失为特征的功能性疾病,主要表现为食管无蠕动和食管下段括约肌(LES)压力升高,食物无法顺利通过该处而滞留于食管内,从而逐渐使食管的张力、蠕动减低及食管扩张的一种疾病。证见吞咽困难、甚至食入即吐、食后胸脘满闷、下端胸骨后疼痛或不适、形体渐致消瘦、精神不振等。中医认为本病多因素体脾胃虚弱,或外邪侵犯,饮食不调或情志内伤,酒色过度而导致胃失和降、胃气上逆所致。本病是少见病,其发病率约为0.5-1/10万,国内中医学界采用传统中医药疗法治疗本病,取得了一定的疗效,现将近15年来的研究进展概述如下。     

贲门失弛缓症经胸部小切口行食管下段肌层切开术

目的 探讨经胸小切口食管肌层切开术治疗贲门失弛缓症的方法和疗效.方法 回顾性分析68例贲门失弛缓症患者经胸部小切口进行食管下段肌层切开手术进行治疗的疗效.左胸第7肋间切口6～8cm,食管下段肌层切开上方超过狭窄1 cm,下方切口至胃壁肌层1 cm.全组均未行抗反流手术.结果 平均手术时间45 min,术后平均住院时间11 d,无手术死亡.1例损伤食管黏膜予以修补,其余无任何并发症.黏膜完整者术后第2天开始进食,行黏膜修补者术后3 d进食.术后随访,66例患者吞咽困难症状改善明显;2例患者吞咽困难症状改善不明显,经胃镜扩张后缓解.全部病例无明显胃食管反流症状.26例行食管pH监测无病理性反流,与术前DeMeesrer评分比较,差异有统计学意义(P<0.05).结论 经胸小切口食管肌层切开术创伤小、恢复快、并发症少,合理掌握胃食管连接部的肌层切开范围可有效防止术后胃食管反流.     

胃镜辅助腹腔镜胃底折叠术治疗贲门失弛缓症16例

贲门失弛缓症是一种由于原发性食管神经-肌肉病变所致的食管运动功能障碍性疾病,以吞咽时食管下括约肌不能正常松弛或松弛不完全为特点。2003年4月-2011年12月,我们采用胃镜辅助腹腔镜胃底折     

腹腔镜联合胃镜下治疗贲门失弛缓症5例

贲门失弛缓症是一种由神经病变所致的食管运动功能障碍性疾病,临床症状顽固。治疗方法较多,目前较为有效的治疗方法为内镜下扩张和外科手术治疗。我院自2002年5月-2003年10月共收治贲门失弛缓症5例,采用腹腔镜联合胃镜下行Heller加胃底折叠术,均取得满意效果。现报告如下。     

软性食管扩张器在贲门失弛缓症治疗中的应用：附233例报告

软性食管扩张器在贲门失弛缓症治疗中的应用（附２３３例报告）陈培朴，陈皓，陈涛，王霞，高学新，谢元忠，张珂，张雷，何光武，孙洪勋笔者自１９８７年５月至１９９３年１月用自制的软性食管扩张器共扩张治疗贲门失弛缓症２３３例，包括曾行Ｈｅｌｌｅｒ手术后仍吞咽困...     

国产支架在食管贲门失弛缓症治疗中的应用（附5例报告）

国产支架在食管贲门失弛缓症治疗中的应用（附５例报告）马贵王志纯张德昌刘布克食管内金属支架已越来越多地应用于临床各类食管狭窄的治疗，其中食管恶性狭窄的支架治疗是较好的适应症，国内外已有报道［１～５］。而应用金属支架治疗食管贲门失弛缓症国内文献报道甚少。...     

贲门失弛缓症合并膈上食管巨大憩室一例

病例资料 患者．男．53岁．吞咽困难30余年，精神紧张时加重。半年来饭后平卧引起呛咳和严重胸骨后烧灼感。胃镜检查：食管距门齿约38cm处右前壁见一直径3．5cm的巨大憩室．食管粘膜粗糙．贲门呈持续收缩状．食管内有大量液体。X线钡餐透视：食管下段呈鸟嘴状狭窄．上端扩张呈白萝卜     

贲门失弛缓症的内镜下诊治

贲门失弛缓症（achalasia,AC）是以食管体部缺乏正常运动、下括约肌（LES）松弛不良为特征,以吞咽困难、胸骨后疼痛为主要临床表现的良性狭窄,是较早被人类认识的食管运动功能障碍性疾病。     

贲门失弛缓症腔内支架术的应用价值

目的　探讨腔内支架术在治疗贲门失弛缓症中的应用价值。方法　对因贲门失弛缓症的患者进行腔内支架术的病例进行了回顾分析。患者共 8例、使用 2种支架材料 ,其中不锈钢支架 2根、镍钛合金支架 6根。支架均经胃镜在X线电视下植入。结果　置放支架均一次成功 ,解除了患者进食困难 ,经 1～ 5年不等的随访 ,5例出现返流性食管炎 (其中 3例发生不同程度的上消化道出血 )。 1例植入支架腔内再狭窄。结论　腔内支架术治疗贲门失弛缓症能疏通患者进食通道 ,改善患者进食能力 ,由于失去正常贲门功能 ,患者出现不同程度的返流性食管炎 ,甚至消化道出血 ,贲门失弛缓症的患者应慎用腔内支架术。     

Secondary achalasia and other esophageal motility disorders after laparoscopic Nissen fundoplication for gastroesophageal reflux disease

OBJECTIVE: The purpose of our investigation was to determine the frequency of secondary achalasia and other esophageal motility disorders revealed on barium studies after laparoscopic Nissen fundoplication and to present the clinical and radiographic findings in these patients. CONCLUSION: Esophageal dysmotility was found in nine (7%) of 138 patients after laparoscopic Nissen fundoplication, including secondary achalasia in three (33%), diffuse esophageal spasm (DES) in two (22%), and a nonspecific esophageal motility disorder in four (44%). Our findings suggest that patients who undergo laparoscopic Nissen fundoplication for gastroesophageal reflux disease are at risk for the development of esophageal motility disorders, including secondary achalasia and DES. Careful evaluation of esophageal motility on postoperative barium studies may help to identify esophageal dysmotility and to differentiate this finding from structural complications of the wrap as a cause of refractory symptoms in these patients.     

Glucagon and gastroesophageal reflux

Using radionuclide gastroesophageal reflux techniques, the effect of glucagon on the occurrence of spontaneous gastroesophageal reflux was tested in 24 normal, asymptomatic volunteers, who served as their own controls. Before glucagon administration, spontaneous gastroesophageal reflux did not occur in any of the volunteers. After 1 mg of glucagon was given, gastroesophageal reflux occurred in two (8%) of the 24 volunteers. Gastroesophageal reflux did not occur after the administration of high-density barium sulfate and an effervescent agent to simulate the circumstances of a routine double-contrast upper gastrointestinal examination. Although the effect of glucagon may facilitate gastroesophageal reflux in a small percentage of normal individuals, most do not exhibit spontaneous gastroesophageal reflux, either before or after glucagon administration.     

Boston专用球囊治疗贲门失弛缓症

目的：回顾总结Boston贲门扩专用球囊治疗贲门失弛缓症26例方法与疗效。方法：在电视监视下经口腔程序置入加强导丝和Boston专用球囊至贲门狭窄部,狭窄严重者需用20－25mm球囊预扩张。用注入15％造影剂方法,循序渐进与间接性扩张,扩至最大直径持续5min后松解,3－5min再次扩张,连续3－4次。结果：26例中球囊放置成功率100％,1次扩张成功24例,2例2次扩张。术后随访2周－31个月,平均10．6个月,无1例复发,吞咽困难缓解率100％。3例轻度食管反流症状。结论：采用Boston直径40mm专用球囊治疗贲门失弛缓症是简便而有效的方法,可以取代外科手术。     

大球囊扩张成形治疗贲门失弛缓症

目的：探讨直径3．5-4．5cm大球囊扩张成形治疗贲门失弛缓症的疗效及价值。方法：透视监视下应用大球囊对34例贲门失弛缓症患者进行扩张治疗。结果：34例中1次扩张治愈32例，2例扩张2次治愈。术后随访24—35月，吞咽困难缓解率100％，l例有轻度食管返流症状，无l例复发。结论：利用大球囊扩张成形治疗贲门失弛缓症安全、有效，值得推广。     

微量射频治疗胃食管反流病安全性评估

 目的 评估微量射频治疗胃食管反流病的安全性.方法 在内镜下施行微量射频治疗胃食管反流病47例,观察患者术前、术中及术后的血压、血氧饱和度和心率变化以及术中不良反应等.结果 术中的收缩压、舒张压较术前均有所下降,清醒后全部恢复正常;术中血氧饱和度较术前有一定程度下降,术后血氧饱和度与术前比较明显改善,差异有统计学意义(P<0.01).结论 微量射频是治疗胃食管反流病的一种新方法,安全可行.     

胃食管反流病的胃排空功能研究

目的　探讨胃食管反流病 (GERD)胃液体、固体排空情况及与pH值监测结果的相关性。方法　 15例GERD患者分别进行胃镜检查、2 4h食管pH值监测和放射性核素胃排空功能测定 ,与对照组液体和固体胃排空率、胃半排空时间进行比较 ,分析GERD患者液体、固体排空率与食管炎及 2 4hpH值监测指标之间的关系。结果　GERD组液体胃排空率在 15、30min明显低于对照组 (P<0 0 5 ) ,固体胃排空率在各时间点均低于对照组 (P <0 0 5 )。GERD患者液体半排空时间与pH值监测总积分无相关性 (r=0 0 6 1,P >0 0 5 ) ;固体半排空时间与pH值监测总积分呈直线相关 (r=0 6 43,P <0 0 5 )。结论　GERD患者存在胃液体、固体排空延迟。固体半排空时间与pH值总积分呈直线相关。胃排空延迟可能是GERD发病机制的重要因素。     

Value of gastroesophageal scintigraphy for the detection of gastroesophageal reflux in infants

50 children with a strong clinical suspicion of gastroesophageal reflux and 10 control patients were evaluated with gastroesophageal scintiscans. 500 muCi à 1 mCi of Tc sulfur colloid mixed the patients' routine milk or formula feeding was administered and serial images of the abdomen and thorax were obtained. A positive scintiscan was found in 35 patients (sensitivity 70%) and none of the controls (specificity 100%). A comparison of findings in 34 patients referred for both radiographic and radionuclide studies showed that barium studies were positive in 38% and radionuclide in 64.7%. We found this examination to be more sensitive that the standard barium radiography particularly in patients with respiratory symptoms. We concluded that the GE scintiscan is complementary to barium studies in the diagnosis of GE reflux. Pulmonary aspiration of gastric contents was detected in only a case of the 35 patients with documented GE reflux. A T 1/2 emptying gastric longer than 90 minutes (linear calculation) or 105 minutes (exponential calculation) is an indirect GE reflux test. This procedure is simple, safe more physiologic than other available examinations.     

Usefulness of gastroesophageal reflux scintigraphy using the knee-chest position for the diagnosis of gastroesophageal reflux disease

OBJECTIVES: The aim of this study is to evaluate the usefulness of gastroesophageal reflux (GER) scintigraphy using the knee-chest (KC) position for the diagnosis of gastroesophageal reflux disease (GERD). METHODS: The study subjects were 37 patients with GERD and 8 healthy volunteers (control group). Endoscopically observed esophageal mucosal breaks were evaluated with the Los Angeles classification. For GER scintigraphy, the subjects ingested liquid yogurt labeled with 99mTc-diethylene triamine pentaacetic acid (99mTc-DTPA) and water. Imaging was performed in the supine and KC position, and GER was graded as 1-4 according to the extent of GER assessed by scintigraphy. RESULTS: GER scintigraphy revealed no reflux in the control group (specificity: 100%). In the supine position, gastroesophageal reflux was observed in 49% of the patients with GERD, compared to 76% in the KC position. 21 of 23 (91%) patients with erosive esophagitis were shown to have GER with scintigraphy. GER scintigraphy revealed severe reflux (grade 3 or 4) (83%, 10/12) in the patients who had severe mucosal breaks (LA grade C or D). GER scintigraphy detected grade 1 or 2 reflux in 7 of the 14 patients who were endoscopically negative. There was a correlation between the endoscopically determined severity of mucosa and the reflux grade which was determined with GER scintigraphy. CONCLUSION: GER scintigraphy can detect gastroesophageal reflux with a high sensitivity in the KC position and might be a useful method in the screening and assessment of the severity of this disease. This method would be useful for the diagnosis of GERD in endoscopically negative patients.     

莫沙必利治疗胃食管反流的临床观察

目的 比较分析枸橼酸莫沙必利与雷贝拉唑钠治疗胃食管反流的临床疗效.方法 入选80例胃食管反流患者,随机分成2组,每组40例,其中对照组予以雷贝拉唑钠治疗,研究组采用枸橼酸莫沙必利治疗.连续治疗4 w后,比较分析两组患者相关临床资料.结果 （1）治疗前,两组间的反流评分、烧心评分、胸痛评分、吞咽不适评分及总症状评分均无统计学差异（P＞0.05）;治疗后,研究组的上述评分均较对照组均有明显改善（P〈0.05）.（2）治疗前,两组的下食道括约肌压力（LESP）、近端最大收缩波幅、远端最大收缩波幅及体部蠕动波传导速度均无统计学差异（P＞0.05）;治疗后,研究组的上述指标均较对照组明显改善（P〈0.05）.（3）通过症状改善评估方法,对照组的总有效率为60.47%,研究组的总有效率为95.35%,二者具有统计学差异（P〈0.05）.研究组治疗后内镜下反流性食管炎分级情况较对照组明显改善（P〈0.05）.（4）两组在不良反应发生率方面没有统计学差异（P＞0.05）.结论 枸橼酸莫沙必利可以很好地改善食管下括约肌功能和食管内酸反流,具有较好的安全性与有效性.