贲门失弛缓症的诊断和治疗进展
摘要
<正>贲门失弛缓症(esophageal achalasia,EA)是由食管胃交界部神经肌肉功能障碍所致的一种功能性疾病~([1]),其特点是食管下括约肌松弛受损和食管蠕动丧失~([2])。目前病因未明,可能与自身免疫、病毒感染、遗传因素和神经退行性变等密切相关。抑制性神经元丢失后,食管下段括约肌(lower esophageal sphincter,LES)舒张功能受损,食管蠕动消失~([3]),食物受阻于食管中而无法进入胃内,早期可无症状,但随着病情的发展
引文
[1] PANDOLFINO J E,GAWRON A J.Achalasia:a systematic review[J].JAMA,2015,313(18):1841-1852.
[2] KRILL J T,NAIK R D,VAEZI M F.Clinical management of achalasia:current state of the art[J].Clin Exp Gastroenterol,2016(9):71-82.
[3] BOECKXSTAENS G E,ZANINOTTO G,RICHTER J E.Achalasia[J].Lancet,2014,383(9911):83-93.
[4] RICHTER J E,BOECKXSTAENS G E.Management of achalasia:surgery or pneumatic dilation[J].Gut,2011,60(6):869-876.
[5] TUSTUMI F,BERNARDO W M,DA ROCHA J R M,et al.Esophageal achalasia:a risk factor for carcinoma.A systematic review and meta-analysis[J].Dis Esophagus,2017,30(10):1-8.
[6] SADOWSKI D C,ACKAH F,JIANG B,et al.Achalasia:incidence,prevalence and survival.A population-based study[J].Neurogastroenterol Motil,2010,22(9):e256-e261.
[7] SAMO S,CARLSON D A,GREGORY D L,et al.Incidence and prevalence of achalasia in central Chicago,2004-2014,since the widespread use of high-resolution manometry[J].Clin Gastroenterol Hepatol,2017,15(3):366-373.
[8] VAEZI M F,PANDOLFINO J E,VELA M F.ACG clinical guideline:diagnosis and management of achalasia[J].Am J Gastroenterol,2013,108(8):1238-1249,1250.
[9] JUNG D H,PARK H.Is Gastroesophageal reflux disease and achalasia coincident or not? [J].Neurogastroenterol Motil,2017,23(1):5-8.
[10] GOCKEL I,ECKARDT V F,SCHMITT T,et al.Pse-udoachalasia:a case series and analysis of the literature[J].Scand J Gastroenterol,2005,40(4):378-385.
[11] FISICHELLA P M,RAZ D,PALAZZO F,et al.Clinical,radiological,and manometric profile in 145 patients with untreated achalasia[J].World J Surg,2008,32(9):1974-1979.
[12] HOWARD P J,MAHER L,PRYDE A,et al.Five year prospective study of the incidence,clinical features,and diagnosis of achalasia in Edinburgh[J].Gut,1992,33(8):1011-1015.
[13] 陈孝平,石应康,邱贵兴,等.外科学(上册)[M].北京:人民卫生出版社,2005:479-480.
[14] TRIADAFILOPOULOS G, BOECKXSTAENS GE, GULLO R,et al.The Kagoshima consensus on esophageal achalasia[J].Dis Esophagus,2012,25(4):337-348.
[15] VAEZI M F,BAKER M E,ACHKAR E,et al.Timed barium oesophagram:better predictor of long term success after pneumatic dilation in achalasia than symptom assessment[J].Gut,2002,50(6):765-770.
[16] 李惠凯,令狐恩强,卢忠生,等.贲门失弛缓症的Ling分型对经口内镜下肌切开术手术成功率的影响[J].中华胃肠内镜电子杂志,2014(1):17-19.
[17] WILLIAMS V A,PETERS J H.Achalasia of the esophagus:a surgical disease[J].J Am Coll Surg,2009,208(1):151-162.
[18] GHOSH S K,PANDOLFINO J E,RICE J,et al.Impaired deglutitive EGJ relaxation in clinical esophageal manometry:a quantitative analysis of 400 patients and 75 controls[J].Am J Physiol Gastrointest Liver Physiol,2007,293(4):G878-G885.
[19] KAHRILAS P J,BREDENOORD A J,FOX M,et al.The Chicago classification of esophageal motility disorders[J].Neurogastroenterol Motil,2015,27(2):160-174.
[20] PRATAP N,KALAPALA R,DARISETTY S,et al.Achalasia cardia subtyping by high-resolution manometry predicts the therapeutic outcome of pneumatic balloon dilatation[J].J Neurogastroenterol Motil,2011,17(1):48-53.
[21] 黄清海,金震东,许国铭.超声内镜及微超声探头诊治贲门失弛缓症[J].世界华人消化杂志,1999(9):787-788.
[22] 钟芸诗,李亮,周平红,等.超声内镜在经口内镜下肌切开术治疗贲门失弛缓症中的应用价值[J].中华消化杂志,2012,32(11):727-730.
[23] VAEZI M F,RICHTER J E.Current therapies for achalasia:comparison and efficacy[J].J Clin Gastroenterol,1998,27(1):21-35.
[24] RICHTER J E.Achalasia-an update[J].J Neurogastroenterol Motil,2010,16(3):232-242.
[25] HOOGERWERF W A,PASRICHA P J.Pharmacologic therapy in treating achalasia[J].Gastrointest Endosc Clin N Am,2001,11(2):311-324.
[26] VITTAL H,PASRICHA P F.Botulinum toxin for gastrointestinal disorders:therapy and mechanisms[J].Neurotox Res,2006,9(2-3):149-159.
[27] JUNG H E,LEE J S,LEE T H,et al.Long-term outcomes of balloon dilation versus botulinum toxin injection in patients with primary achalasia[J].Korean J Intern Med,2014,29(6):738-745.
[28] WANG L,LI Y M,LI L,et al.A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia[J].World J Gastroenterol,2008,14(38):5900-5906.
[29] GALASSI G,ORLANDI C,VALZANIA F,et al.Botulin toxin type A(BTA) for esophageal achalasia:a double-edged sword[J].Int J Colorectal Dis,2011,26(8):1079-1080.
[30] FARHOOMAND K, CONNOR J T, RICHTER J E, et al.Predictors of outcome of pneumatic dilation in achalasia[J].Clin Gastroenterol Hepatol,2004,2(5):389-394.
[31] HULSELMANS M,VANUYTSEL T,DEGREEF T,et al.Long-term outcome of pneumatic dilation in the treatment of achalasia[J].Clin Gastroenterol Hepatol,2010,8(1):30-35.
[32] ZERBIB F,THETIOT V,RICHY F,et al.Repeated pneumatic dilations as long-term maintenance therapy for esophageal achalasia[J].Am J Gastroenterol,2006,101(4):692-697.
[33] BOROTTO E,GAUDRIC M,DANEL B,et al.Risk factors of oesophageal perforation during pneumatic dilatation for achalasia[J].Gut,1996,39(1):9-12.
[34] VANUYTSEL T,LERUT T,COOSEMANS W,et al.Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia[J].Clin Gastroenterol Hepatol,2012,10(2):142-149.
[35] 程英升,李明华,杨仁杰,等.贲门失弛缓症的四种介入治疗成形术的选择和中远期疗效比较[J].介入放射学杂志,2006,15(7):413-417.
[36] CHENG Y S,MA F,LI Y D,et al.Temporary self-expanding metallic stents for achalasia:a prospective study with a long-term follow-up[J].World J Gastroenterol,2010,16(40):5111-5117.
[37] INOUE H,MINAMI H,KOBAYASHI Y,et al.Peroral endoscopic myotomy(POEM) for esophageal achalasia[J].Endoscopy,2010,42(4):265-271.
[38] IHARA E,MUTA K,FUKAURA K,et al.Diagnosis and treatment strategy of achalasia subtypes and esophagogastric junction outflow obstruction based on high-resolution manometry[J].Digestion,2017,95(1):29-35.
[39] NGAMRUENGPHONG S, INOUE H, CHIU P W, et al.Long-term outcomes of per-oral endoscopic myotomy in patients with achalasia with a minimum follow-up of 2 years:an international multicenter study[J].Gastrointest Endosc,2017,85(5):927-933.
[40] SCHLOTTMANN F,LUCKETT DJ,FINE J,et al.Laparoscopic heller myotomy versus peroral endoscopic myotomy(POEM) for achalasia:a systematic review and meta-analysis[J].Ann Surg,2018,267(3):451-460.
[41] ZHANG W G,LINGHU E Q,LI H K.Fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy:a retrospective study at a single center[J].World J Gastroenterol,2017,23(9):1637-1644.
[42] STAVROPOULOS S N,MODAYIL R J,FRIEDEL D,et al.The international per oral endoscopic myotomy survey(IPOEMS):a snapshot of the global POEM experience[J].Surg Endosc,2013,27(9):3322-3338.
[43] SCHLOTTMANN F, ANDOLFI C, KAVITT R T, et al.Multidisciplinary approach to esophageal achalasia:a single center experience[J].J Laparoendosc Adv Surg Tech A,2017,27(4):358-362.
[45] SALVADOR R,COSTANTINI M,ZANINOTTO G,et al.The preoperative manometric pattern predicts the outcome of surgical treatment for esophageal achalasia[J].J Gastrointest Surg,2010,14(11):1635-1645.
[46] CAMPOS G M,VITTINGHOFF E,RABL C,et al.Endoscopic and surgical treatments for achalasia:a systematic review and meta-analysis[J].Ann Surg,2009,249(1):45-57.
[47] MOLENA D,YANG S C.Surgical management of end-stage achalasia[J].Semin Thorac Cardiovasc Surg,2012,24(1):19-26.
[48] NIKNAM R,MIKAELI J,MEHRABI N,et al.Ethanolamine oleate in resistant idiopathic achalasia:a novel therapy[J].Eur J Gastroenterol Hepatol,2011,23(12):1111-1115.
[49] MIKAELI J,VEISARI A K,FAZLOLLAHI N,et al.Ethanolamine oleate versus botulinum toxin in the treatment of idiopathic achalasia[J].Ann Gastroenterol,2015,28(2):229-235.
[2] KRILL J T,NAIK R D,VAEZI M F.Clinical management of achalasia:current state of the art[J].Clin Exp Gastroenterol,2016(9):71-82.
[3] BOECKXSTAENS G E,ZANINOTTO G,RICHTER J E.Achalasia[J].Lancet,2014,383(9911):83-93.
[4] RICHTER J E,BOECKXSTAENS G E.Management of achalasia:surgery or pneumatic dilation[J].Gut,2011,60(6):869-876.
[5] TUSTUMI F,BERNARDO W M,DA ROCHA J R M,et al.Esophageal achalasia:a risk factor for carcinoma.A systematic review and meta-analysis[J].Dis Esophagus,2017,30(10):1-8.
[6] SADOWSKI D C,ACKAH F,JIANG B,et al.Achalasia:incidence,prevalence and survival.A population-based study[J].Neurogastroenterol Motil,2010,22(9):e256-e261.
[7] SAMO S,CARLSON D A,GREGORY D L,et al.Incidence and prevalence of achalasia in central Chicago,2004-2014,since the widespread use of high-resolution manometry[J].Clin Gastroenterol Hepatol,2017,15(3):366-373.
[8] VAEZI M F,PANDOLFINO J E,VELA M F.ACG clinical guideline:diagnosis and management of achalasia[J].Am J Gastroenterol,2013,108(8):1238-1249,1250.
[9] JUNG D H,PARK H.Is Gastroesophageal reflux disease and achalasia coincident or not? [J].Neurogastroenterol Motil,2017,23(1):5-8.
[10] GOCKEL I,ECKARDT V F,SCHMITT T,et al.Pse-udoachalasia:a case series and analysis of the literature[J].Scand J Gastroenterol,2005,40(4):378-385.
[11] FISICHELLA P M,RAZ D,PALAZZO F,et al.Clinical,radiological,and manometric profile in 145 patients with untreated achalasia[J].World J Surg,2008,32(9):1974-1979.
[12] HOWARD P J,MAHER L,PRYDE A,et al.Five year prospective study of the incidence,clinical features,and diagnosis of achalasia in Edinburgh[J].Gut,1992,33(8):1011-1015.
[13] 陈孝平,石应康,邱贵兴,等.外科学(上册)[M].北京:人民卫生出版社,2005:479-480.
[14] TRIADAFILOPOULOS G, BOECKXSTAENS GE, GULLO R,et al.The Kagoshima consensus on esophageal achalasia[J].Dis Esophagus,2012,25(4):337-348.
[15] VAEZI M F,BAKER M E,ACHKAR E,et al.Timed barium oesophagram:better predictor of long term success after pneumatic dilation in achalasia than symptom assessment[J].Gut,2002,50(6):765-770.
[16] 李惠凯,令狐恩强,卢忠生,等.贲门失弛缓症的Ling分型对经口内镜下肌切开术手术成功率的影响[J].中华胃肠内镜电子杂志,2014(1):17-19.
[17] WILLIAMS V A,PETERS J H.Achalasia of the esophagus:a surgical disease[J].J Am Coll Surg,2009,208(1):151-162.
[18] GHOSH S K,PANDOLFINO J E,RICE J,et al.Impaired deglutitive EGJ relaxation in clinical esophageal manometry:a quantitative analysis of 400 patients and 75 controls[J].Am J Physiol Gastrointest Liver Physiol,2007,293(4):G878-G885.
[19] KAHRILAS P J,BREDENOORD A J,FOX M,et al.The Chicago classification of esophageal motility disorders[J].Neurogastroenterol Motil,2015,27(2):160-174.
[20] PRATAP N,KALAPALA R,DARISETTY S,et al.Achalasia cardia subtyping by high-resolution manometry predicts the therapeutic outcome of pneumatic balloon dilatation[J].J Neurogastroenterol Motil,2011,17(1):48-53.
[21] 黄清海,金震东,许国铭.超声内镜及微超声探头诊治贲门失弛缓症[J].世界华人消化杂志,1999(9):787-788.
[22] 钟芸诗,李亮,周平红,等.超声内镜在经口内镜下肌切开术治疗贲门失弛缓症中的应用价值[J].中华消化杂志,2012,32(11):727-730.
[23] VAEZI M F,RICHTER J E.Current therapies for achalasia:comparison and efficacy[J].J Clin Gastroenterol,1998,27(1):21-35.
[24] RICHTER J E.Achalasia-an update[J].J Neurogastroenterol Motil,2010,16(3):232-242.
[25] HOOGERWERF W A,PASRICHA P J.Pharmacologic therapy in treating achalasia[J].Gastrointest Endosc Clin N Am,2001,11(2):311-324.
[26] VITTAL H,PASRICHA P F.Botulinum toxin for gastrointestinal disorders:therapy and mechanisms[J].Neurotox Res,2006,9(2-3):149-159.
[27] JUNG H E,LEE J S,LEE T H,et al.Long-term outcomes of balloon dilation versus botulinum toxin injection in patients with primary achalasia[J].Korean J Intern Med,2014,29(6):738-745.
[28] WANG L,LI Y M,LI L,et al.A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia[J].World J Gastroenterol,2008,14(38):5900-5906.
[29] GALASSI G,ORLANDI C,VALZANIA F,et al.Botulin toxin type A(BTA) for esophageal achalasia:a double-edged sword[J].Int J Colorectal Dis,2011,26(8):1079-1080.
[30] FARHOOMAND K, CONNOR J T, RICHTER J E, et al.Predictors of outcome of pneumatic dilation in achalasia[J].Clin Gastroenterol Hepatol,2004,2(5):389-394.
[31] HULSELMANS M,VANUYTSEL T,DEGREEF T,et al.Long-term outcome of pneumatic dilation in the treatment of achalasia[J].Clin Gastroenterol Hepatol,2010,8(1):30-35.
[32] ZERBIB F,THETIOT V,RICHY F,et al.Repeated pneumatic dilations as long-term maintenance therapy for esophageal achalasia[J].Am J Gastroenterol,2006,101(4):692-697.
[33] BOROTTO E,GAUDRIC M,DANEL B,et al.Risk factors of oesophageal perforation during pneumatic dilatation for achalasia[J].Gut,1996,39(1):9-12.
[34] VANUYTSEL T,LERUT T,COOSEMANS W,et al.Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia[J].Clin Gastroenterol Hepatol,2012,10(2):142-149.
[35] 程英升,李明华,杨仁杰,等.贲门失弛缓症的四种介入治疗成形术的选择和中远期疗效比较[J].介入放射学杂志,2006,15(7):413-417.
[36] CHENG Y S,MA F,LI Y D,et al.Temporary self-expanding metallic stents for achalasia:a prospective study with a long-term follow-up[J].World J Gastroenterol,2010,16(40):5111-5117.
[37] INOUE H,MINAMI H,KOBAYASHI Y,et al.Peroral endoscopic myotomy(POEM) for esophageal achalasia[J].Endoscopy,2010,42(4):265-271.
[38] IHARA E,MUTA K,FUKAURA K,et al.Diagnosis and treatment strategy of achalasia subtypes and esophagogastric junction outflow obstruction based on high-resolution manometry[J].Digestion,2017,95(1):29-35.
[39] NGAMRUENGPHONG S, INOUE H, CHIU P W, et al.Long-term outcomes of per-oral endoscopic myotomy in patients with achalasia with a minimum follow-up of 2 years:an international multicenter study[J].Gastrointest Endosc,2017,85(5):927-933.
[40] SCHLOTTMANN F,LUCKETT DJ,FINE J,et al.Laparoscopic heller myotomy versus peroral endoscopic myotomy(POEM) for achalasia:a systematic review and meta-analysis[J].Ann Surg,2018,267(3):451-460.
[41] ZHANG W G,LINGHU E Q,LI H K.Fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy:a retrospective study at a single center[J].World J Gastroenterol,2017,23(9):1637-1644.
[42] STAVROPOULOS S N,MODAYIL R J,FRIEDEL D,et al.The international per oral endoscopic myotomy survey(IPOEMS):a snapshot of the global POEM experience[J].Surg Endosc,2013,27(9):3322-3338.
[43] SCHLOTTMANN F, ANDOLFI C, KAVITT R T, et al.Multidisciplinary approach to esophageal achalasia:a single center experience[J].J Laparoendosc Adv Surg Tech A,2017,27(4):358-362.
[45] SALVADOR R,COSTANTINI M,ZANINOTTO G,et al.The preoperative manometric pattern predicts the outcome of surgical treatment for esophageal achalasia[J].J Gastrointest Surg,2010,14(11):1635-1645.
[46] CAMPOS G M,VITTINGHOFF E,RABL C,et al.Endoscopic and surgical treatments for achalasia:a systematic review and meta-analysis[J].Ann Surg,2009,249(1):45-57.
[47] MOLENA D,YANG S C.Surgical management of end-stage achalasia[J].Semin Thorac Cardiovasc Surg,2012,24(1):19-26.
[48] NIKNAM R,MIKAELI J,MEHRABI N,et al.Ethanolamine oleate in resistant idiopathic achalasia:a novel therapy[J].Eur J Gastroenterol Hepatol,2011,23(12):1111-1115.
[49] MIKAELI J,VEISARI A K,FAZLOLLAHI N,et al.Ethanolamine oleate versus botulinum toxin in the treatment of idiopathic achalasia[J].Ann Gastroenterol,2015,28(2):229-235.