43例贲门失弛缓症患者回顾分析
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摘要
目的:探讨关于贲门失弛缓症(achalasia,AC)的检查及治疗方案的临床意义。方法:搜集西南医科大学附属医院消化内科2014年1月至2017年6月确诊为AC的43例住院患者信息,使用SPSS 17.0进行整理分析。结果:43例AC患者中男女比为1.05.1,差异无统计学意义(P>0.05),发病年龄以50~59岁为发病高峰。有诱因者比例高于无诱因者(2.3.1),诱因中饮食、情绪、精神三者对AC的发病差异无统计学意义(P=0.866)。最常见的症状为反酸和(或)烧心(67.4%),最易合并胃食管反流病(gastroesophageal reflux disease,GERD)。钡餐造影(阳性率81.4%)及胃镜(阳性率48.8%)检查差异有统计学意义(P=0.019),经口内镜下肌切开术(peroral endoscopic myotomy,POEM)较药物及水囊扩张更有效,有效率分别为85.7%,30.0%,37.5%,差异有统计学意义(P=0.033)。结论:在AC的诊断中钡餐造影检查阳性率高于胃镜,药物及水囊扩张为多数人选择的治疗方式,但POEM较前两者更为有效。在AC的诊治过程中,选择更为优化的诊疗方案有利于提高患者预后。
Objective:To investigate the clinical significance of the examination and therapeutic regimens for achalasia of cardia(AC).Methods:We collected the information of 43 inpatients diagnosed with AC in department of gastroenterology,the affiliated hospital of southwest medical university,from January 2014 to June 2017.The obtained information was analyzed using SPSS 17.0.Results:In the 43 cases of AC,the male-to-female ratio was1.05.1,with no significant difference in the number of cases between male and female patients(P>0.05).The age of onset 50-59 years in most cases.There were more patients with predisposing factors than those without predisposing factors(2.3.1),and the contribution to AC was not significantly different between dietary,emotional,and mental factors(P=0.866).The most common symptoms were acid reflux and(or)heartburn(67.4%),and the most frequent complication was gastroesophageal reflux disease.There was a significant difference in the positive rate between barium meal examination and gastroscopy(81.4%vs 48.8%,P=0.019).Peroral endoscopic myotomy(PO-EM)was more effective than drug treatment and water sac expansion in the treatment of AC(85.7%vs 30.0%/37.5%,P=0.033).Conclusion:Barium meal examination has a higher positive rate than gastroscopy in the diagnosis of AC.Although drug treatment and water sac expansion are used in most patients,POEM is more effective than the two therapies.In the diagnosis and treatment of AC,optimized regimens help improve the prognosis of patients.
Objective:To investigate the clinical significance of the examination and therapeutic regimens for achalasia of cardia(AC).Methods:We collected the information of 43 inpatients diagnosed with AC in department of gastroenterology,the affiliated hospital of southwest medical university,from January 2014 to June 2017.The obtained information was analyzed using SPSS 17.0.Results:In the 43 cases of AC,the male-to-female ratio was1.05.1,with no significant difference in the number of cases between male and female patients(P>0.05).The age of onset 50-59 years in most cases.There were more patients with predisposing factors than those without predisposing factors(2.3.1),and the contribution to AC was not significantly different between dietary,emotional,and mental factors(P=0.866).The most common symptoms were acid reflux and(or)heartburn(67.4%),and the most frequent complication was gastroesophageal reflux disease.There was a significant difference in the positive rate between barium meal examination and gastroscopy(81.4%vs 48.8%,P=0.019).Peroral endoscopic myotomy(PO-EM)was more effective than drug treatment and water sac expansion in the treatment of AC(85.7%vs 30.0%/37.5%,P=0.033).Conclusion:Barium meal examination has a higher positive rate than gastroscopy in the diagnosis of AC.Although drug treatment and water sac expansion are used in most patients,POEM is more effective than the two therapies.In the diagnosis and treatment of AC,optimized regimens help improve the prognosis of patients.
引文
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9.Reas DL,Zipfel S,Ro O.Is it an eating disorder or achalasia or both?A literature review and diagnostic challenges[J].Eur Eat Disord Rev,2014,22(5):321-330.
10.Francis DL,Katzka DA.Achalasia:update on the disease and its treatment[J].Gastroenterology,2010,139(2):369-374.
11.Bredenoord A J,Fox M,Kahrilas P J,et al.Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography[J].Neurogastroenterol Motil,2012,24 Suppl 1:57-65.
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13.Vela MF.Management strategies for achalasia[J].Neurogastroenterol Motil,2014,26(9):1 215-1 221.
14.Vaezi MF,Pandolfino JE,Vela MF.ACG clinical guideline:diagnosis and management of achalasia[J].Am J Gastroenterol,2013,108(8):1 238-1 250.
15.Persson J,Johnsson E,Kostic S,et al.Treatment of achalasia with laparoscopic myotomy or pneumatic dilatation:long-term results of a prospective,randomized study[J].World J Surg,2015,39(3):713-720.
16.Fuchs KH,Schulz T,Varga G,et al.The potential and perspective of peroral endoscopic esophageal myotomy for achalasia[J].World J Surg,2015,39(7):1 598-1 602.
17.Ujiki MB,Yetasook AK,Zapf M,et al.Peroral endoscopic myotomy:A short-term comparison with the standard laparoscopic approach[J].Surgery,2013,154(4):893-900.
18.Von Renteln D,Fuchs KH,Fockens P,et al.Peroral endoscopic myotomy for the treatment of achalasia:an international prospective multicenter study[J].Gastroenterology,2013,145(2):309-311.
19.Tuason J,Inoue H.Current status of achalasia management:a review on diagnosis and treatment[J].J Gastroenterol,2017,52(4):401-406.
20.Patel K,Abbassi-Ghadi N,Markar S,et al.Peroral endoscopic myotomy for the treatment of esophageal achalasia:systematic review and pooled analysis[J].Dis Esophagus,2016,29(7):807-819.
21.Youn YH,Minami H,Chiu PW,et al.Peroral endoscopic myotomy for treating achalasia and esophageal motility disorders[J].J Neurogastroenterol Motil,2016,22(1):14-24.
2.王刚,张逊.贲门失弛缓症的治疗现状及进展[J].中国胸心血管外科临床杂志,2014,1:107-111.
3.张月.49例贲门失弛缓症病例回顾分析[D].大连医科大学,2017.
4.Pandolfino J E,Ghosh S K,Rice J,et al.Classifying esophageal motility by pressure topography characteristics a study of 400 patients and 75 controls[J].Am J Gastroenterol.2008,103(1):27-37.
5.Tuason J,Inoue H.Current status of achalasia management:a review on diagnosis and treatment[J].J Gastroenterol.2017,52(4):401-406.
6.李淑香,曲波,李惠.贲门失弛缓症发病机制的研究进展[J].世界华人消化杂志,2015,8:1 252-1 257.
7.Arora Z,Thota PN,Sanaka MR.Achalasia:current therapeutic options[J].Ther Adv Chronic Dis,2017,8(6-7):101-108.
8.Krill JT,Naik R D,Vaezi MF.Clinical management of achalasia:current state of the art[J].Clin Exp Gastroenterol,2016,9:71-82.
9.Reas DL,Zipfel S,Ro O.Is it an eating disorder or achalasia or both?A literature review and diagnostic challenges[J].Eur Eat Disord Rev,2014,22(5):321-330.
10.Francis DL,Katzka DA.Achalasia:update on the disease and its treatment[J].Gastroenterology,2010,139(2):369-374.
11.Bredenoord A J,Fox M,Kahrilas P J,et al.Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography[J].Neurogastroenterol Motil,2012,24 Suppl 1:57-65.
12.Kessing BF,Bredenoord AJ,Smout AJ.Erroneous diagnosis of gastroesophageal reflux disease in achalasia[J].Clin Gastroenterol Hepatol,2011,9(12):1 020-1 024.
13.Vela MF.Management strategies for achalasia[J].Neurogastroenterol Motil,2014,26(9):1 215-1 221.
14.Vaezi MF,Pandolfino JE,Vela MF.ACG clinical guideline:diagnosis and management of achalasia[J].Am J Gastroenterol,2013,108(8):1 238-1 250.
15.Persson J,Johnsson E,Kostic S,et al.Treatment of achalasia with laparoscopic myotomy or pneumatic dilatation:long-term results of a prospective,randomized study[J].World J Surg,2015,39(3):713-720.
16.Fuchs KH,Schulz T,Varga G,et al.The potential and perspective of peroral endoscopic esophageal myotomy for achalasia[J].World J Surg,2015,39(7):1 598-1 602.
17.Ujiki MB,Yetasook AK,Zapf M,et al.Peroral endoscopic myotomy:A short-term comparison with the standard laparoscopic approach[J].Surgery,2013,154(4):893-900.
18.Von Renteln D,Fuchs KH,Fockens P,et al.Peroral endoscopic myotomy for the treatment of achalasia:an international prospective multicenter study[J].Gastroenterology,2013,145(2):309-311.
19.Tuason J,Inoue H.Current status of achalasia management:a review on diagnosis and treatment[J].J Gastroenterol,2017,52(4):401-406.
20.Patel K,Abbassi-Ghadi N,Markar S,et al.Peroral endoscopic myotomy for the treatment of esophageal achalasia:systematic review and pooled analysis[J].Dis Esophagus,2016,29(7):807-819.
21.Youn YH,Minami H,Chiu PW,et al.Peroral endoscopic myotomy for treating achalasia and esophageal motility disorders[J].J Neurogastroenterol Motil,2016,22(1):14-24.