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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)扩张后患者的临床症状明显改善 ,且持续 1年 (P <0 .0 1)。 ( 2 )扩张后 3天至 1年 ,LESP、LESR均有改善 (P <0 .0 0 1、P <0 .0 5 ) ,以LESP下降尤为明显。 ( 3)扩张治疗前、治疗后 3天及 3月LESP <2 .5kPa分别为 6 1次和 11次 (P<0 .0 0 1) ,扩张前后LESR >80 %分别占 8.9%和 2 3.0 % (P <0 .0 0 1)。 ( 4 )扩张前全部病例食管体部均为非推进性同步收缩波 ,治疗后 3天、3月及 1年随访观察 ,仅 1例患者食管体部部分恢复推进性蠕动收缩。结论 :气囊扩张治疗贲门失弛缓症疗效好 ,不仅降低LESP而且改善LESR、缓解临床症状。选择气囊扩张治疗后是否再次扩张的主要观察指标除临床症状外 ,食管测压是最主要的随访方法 ,其中动力指标除LESP外 ,还需考虑LESR。
OBJECTIVE: To study esophageal manometry in 17 patients with cardiac achalasia before and after dilatation, and to study the relationship between esophageal motility and dilatation efficacy in patients with achalasia. Methods: Seventeen patients with achalasia were diagnosed according to clinical manifestations, barium meal, endoscopy and esophageal manometry, and balloon dilatation was performed after diagnosis. 17 cases before dilation treatment, within 3 days after treatment and in March, 10 cases 1 year after treatment to observe clinical symptom score and manometry index. Results: (1) The clinical symptoms of patients after dilatation were significantly improved for 1 year (P <0.01). (2) Both LESP and LESR improved from 3 days to 1 year after dilation (P <0.01, P <0.05), especially in LESP. (3) Before and after treatment, LESP <2.5kPa were 6 1 and 11 times (P <0.01) before and 3 days after treatment and LESR> 80% before and after dilation, accounting for 8.9% and 2 3.0 respectively % (P <0 .0 0 1). (4) The esophageal body of all the cases before expansion were all non-propulsive systolic wave. After 3 days, 3 months and 1 year follow-up, only one case of esophageal body restored propulsive peristalsis contraction. Conclusion: The balloon dilation is effective in treating achalasia, which not only reduces LESP but also improves LESR and relieves clinical symptoms. In addition to clinical symptoms, esophageal manometry is the most important follow-up method, in which the power index in addition to LESP, the need to consider LESR.