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目的研究金属可回收防反流食管支架治疗贲门失弛缓的临床疗效、术后的食管动力学变化。方法选择21例贲门失弛缓患者,经临床评估、内镜检测后置入金属防反流食管支架,使其越过贲门狭窄段。支架置入期间密切观察临床变化,以及患者的耐受性。术后1个月在内镜下取出食管支架,然后分别于支架取出后1周、术后6、12个月对患者密切随访,评估临床表现,再比较分析。结果所有患者均成功置入食管支架。支架置入期间,5例(23.8%)患者出现持续胸骨后疼痛,2例(9.3%)患者出现间歇胸骨后烧灼样疼痛,2例(9.3%)支架发生移位,1例脱入胃腔。大多数患者在支架术前出现不同程度的吞咽困难、胸痛、呕吐和反酸;支架取出后1周、6、12个月吞咽困难、胸痛及呕吐发生率较术前显著降低;术后12个月吞咽困难、胸痛发生率较术后1周、6个月组显著升高;支架取出后1周及取出后6、12个月反酸发生率较术前显著升高。结论贲门失弛缓患者对金属可回收食管支架具有良好的耐受力,该型支架能显著改善贲门失弛缓患者的临床症状,术后6个月开始临床复发率逐步升高。
Objective To study the clinical efficacy of esophageal stents with recoverable reflux preventing esophageal aplasia and esophageal dynamic changes after operation. Methods Twenty-one patients with cardiac achalasia were selected. After clinical evaluation and endoscopic examination, metal anti-reflux esophageal stent was placed to cross the cardia stenosis. Closely observe clinical changes during stenting and patient tolerance. One month after surgery, esophageal stents were removed endoscopically, followed by close follow-up one week after stent removal and 6 and 12 months after surgery, respectively. The clinical manifestations were evaluated and compared. Results All patients were successfully placed in esophageal stents. During the stent implantation, 5 patients (23.8%) had sustained sternal pain, 2 (9.3%) patients had intermittent sternal burn-like pain, 2 (9.3%) stents were displaced and 1 patient was detached into the gastric cavity . Most patients had varying degrees of dysphagia, chest pain, vomiting and acid reflux before stent implantation. The incidence of dysphagia, chest pain and vomiting at 6 weeks and 12 months after stent removal was significantly lower than those before surgery. Twelve Month dysphagia, the incidence of chest pain than the postoperative 1 week, 6 months group was significantly increased; 1 week after removal of the stent and 6,12 months after taking the acid reflux rate was significantly higher than the preoperative. Conclusions Patients with achalasia have good tolerance to recoverable esophageal stents. The stent can significantly improve the clinical symptoms of patients with achalasia. The clinical relapse rate gradually increases from 6 months after operation.