胃镜下气囊扩张治疗贲门失弛缓症的疗效及随访观察

目的 评价胃镜下用Rigiflex气囊扩张器治疗原发性贲门失弛缓症的近期及远期疗效.方法 经临床症状、食管钡餐、食管测压和胃镜检查确诊的125例贲门失弛缓症患者在胃镜下用直径为3.5 cm的Rigiflex气囊扩张器进行扩张,术后根据临床症状积分、食管体正常蠕动率（EPR）、下食管括约肌静息压（LESBP）、下食管括约肌松弛率（LESRR）、下食管括约肌松弛度（LESRD）、食管钡餐和胃镜进行术后1月、6月、1年、3年和5年的随访.结果 治疗后1月内所有患者临床症状积分、LESBP、食管钡餐和胃镜均显著改善（P＜0.01）,EPR、LESRR和LESRD均无显著改善（P＞0.05）,5年随访中有7例复发,有效率达92.14%.治疗中1例出现食管穿孔.结论 在胃镜下用直径3.5 cm的Rigiflex气囊扩张器治疗原发性贲门失弛缓症是非常有效的方法,疗效较持久.随访中间歇性出现的临床症状可能与失调的食管蠕动和LES的松弛有密切关系.

Evaluation of Pneumatic Ballon Dilation for Treatment of Primary Achalasia Under Gastroendoscopy

Objective To evaluate the efficacy of pneumatic ballon dilation in treatment for primary achalasia under gastroendoscopy.Methods 125 primary achalasia patients diagnosed by means of clinical symptoms,esophageal barium X-ray,esophageal manometry and gastroendoscopy,were treated with Rigiflex pneumatic ballon dilator with 3.5 cm diameter under gastroendoscopy,and the results were analized and followed up according to clinical symptom scores,EPR,LESBP,LESRR,LESRD,X-ray and gastroendoscopy after 1 month,6 months,1 year,3 years and 5 years.Results After 1 month treatment,all the patients showed absolutely significant improvement according to clinlical symptom scores,LESBP,X-ray and gastroendoscopy(P<0.01),but not significantly improved in EPR,LESRD and LESRR(P>0.05).Of 89 patients with 5 years follow-up,7 patients relapsed.The efficacy of five years was 92.14%.Only one patient suffered from esophageal perforation.Conclusion Under gastroendoscopy,the treatment with Rigiflex pneumatic ballon dilator in 3.5 cm diameter for primary achalasia should be persistently effective in 5 yeass follow-up.The intermittent clinical symptoms may be closely related with the disturbance of normal esophageal peristalsis and LES relaxation.