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目的 探讨气囊扩张对贲门失弛缓症患者食管动力的影响及与扩张疗效的关系。方法 4 8例经临床、钡餐造影、内镜检查及食管测压确诊的贲门失弛缓症 ,采用上消化道动力监测系统。观察扩张前和扩张后 4周以及 12～ 2 4周时的症状计分、钡餐造影显示的食管最大宽度、下食管括约肌压力(LESP)、下食管括约肌松弛率 (LESRR)及食管体部收缩振幅。结果 ①扩张后吞咽困难、胸痛和反食症状的计分以及食管的最大宽度均明显低于扩张前 (P <0 .0 5 )。②扩张后 4周、12～ 2 4周 4个方位的LESP明显降低 (P <0 .0 5 ) ,4个方位相应的LESRR扩张后较扩张前明显增加 (P <0 .0 5 )。③扩张前后LESP <2 .6 7kPa次数百分比分别为 4 5 .4 1% ,82 .4 8%和 85 .87% (与扩张前比P <0 .0 5 ) ,LESRR≥80 %的次数百分比分别占 6 .74 % ,5 5 .97%和 4 3.78% (与扩张前比P <0 .0 5 )。④ 4 8例患者中未发现食管体部恢复推进性蠕动波。食管体部收缩振幅扩张前 ,后均表现为无效收缩。结论 ①气囊扩张治疗贲门失弛缓症近期、中期疗效较好 ,并有维持治疗作用。②气囊扩张不仅降低LESP且改善LESRR ,是气囊扩张缓解症状、减少食管扩张程度的重要病理生理改变的基础。提示是否再行扩张的食管动力指标除LESP外 ,还要考虑LESRR。
Objective To investigate the effect of balloon dilatation on esophageal motility in patients with achalasia and its relationship with dilatation and curative effect. Methods Forty-eight patients with achalasia diagnosed by clinical, barium meal angiography, endoscopy and esophageal manometry were enrolled in the upper gastrointestinal motility monitoring system. Symptom scores at 4 and 12 to 24 weeks before and after dilation, maximum esophageal width under barium meal, lower esophageal sphincter pressure (LESP), lower esophageal sphincter relaxation rate (LESRR) and esophageal body contraction amplitude . Results ① After dilation, dysphagia, chest pain and anti-esophageal symptom scores and the maximum esophageal width were significantly lower than those before dilation (P <0.05). ② After 4 weeks of dilation, the LESP in 4 azimuthal directions at 12 ~ 24 weeks decreased significantly (P <0.05), and the LESRR at 4 azimuthal angles increased significantly compared with that before dilation (P <0.05). ③ The percentages of LESP <2.67kPa before and after dilation were 45.41%, 82.48% and 85.87% respectively (P <0.05 before expansion), the percentage of LESRR≥80% Accounting for 6 .74%, 55.97% and 4 3.78%, respectively (P <0. 05 before expansion). ④ There was no recovery of propulsive peristalsis in esophageal body in 48 patients. Esophageal body contraction amplitude before and after expansion showed ineffective contraction. Conclusion ① balloon dilatation of achalasia in the near future, the mid-term better effect, and maintain the role of treatment. ② balloon dilation not only reduce LESP and improve LESRR, balloon dilation to relieve symptoms and reduce the degree of esophageal expansion of the important pathophysiological basis. Esophageal motility indicators that suggest whether to dilate again include LESRR in addition to LESP.