贲门失弛缓症治疗方式的探讨

目的比较胸腔镜辅助Heller手术、开胸Heller手术、消化内镜下球囊扩张及消化内镜下肉毒毒素注射治疗贲门失弛缓症疗效，探讨贲门失弛缓症合理有效的治疗方法。方法81例贲门失弛缓症患者按不同治疗方式分为4组：胸腔镜辅助Heller手术18例；开胸Heller手术21例；消化内镜下球囊扩张22例；肉毒毒素注射治疗20例。比较各组治疗前后症状评分、食管末端直径、食管下段括约肌压力、食管末端pH和各组有效率。结果4组患者治疗前后相比，症状评分、食管末端直径、食管下段括约肌压力、食管末端pH差异均有统计学意义（P〈0．05），治疗有效率胸腔镜组为94．4％、开胸组为95．2％、球囊扩张组为63．6％、肉毒素注射组为55．0％，Heller手术较消化内镜下治疗更为有效（P〈0．05）。结论Heller手术治疗效果较球囊扩张及肉毒素注射为佳，胸腔镜辅助Heller手术较开胸Heller手术具有创伤小、恢复快、住院时间短等优势。

The Study on different treatment procedures for achalasia

Objective To study on achalasia treated by four different procedures,and to find out the best suitable and effective one.Methods Eighty one cases of achalasia were allocated into 4 groups in rantom:18 cases underwent video-assisted thoracoscopic Heller's myotomy;21 cases received Heller's myot- omy through thoracotomy;22 cases received endoscopic balloon dilation and 20 cases received endoscopic botulinum toxin injection.The symptom scores,the diameter of lower esophagus,the lower esophageal sphincter pressure,the average pre-treatment and post-treatment pH of distal esophagus in each group and the rates of effectiveness in four groups were compared.Results All of the post treatment data in symptom scores,diameter of lower esophagus,lower esophageal sphincter pressure,average pH of distal esophagus show statistically significant difference as compared with those of pretreatment(P<0.05).The effective rates in these four groups were 94.4%,95.2%,63.6%,and 55.0% respectively.There were statistically sig- nificant differences in comparing Heller's myotomy with endoscopic balloon dilation or botulinum toxin injec- tion(P<0.05).Conclusion The clinical effectiveness of Heller's myotomy is superior to that of endoscop- ic balloon dilation or endoscopic botulinum toxin injection.Video-assisted thoracoscopic Heller's myotomy has the superiority of less traumatic,readily recovery and shorter hospital stay as comparing to thoracotomy. So that Video-assisted thoracoscopic Heller's myotomy is a more suitable and effective procedure for achala- sia.