Eckardt V F, Kanzler G, Willems D
Gastroenterologisches Institut, Wiesbaden, Germany.
Dig Dis Sci. 1992 Apr;37(4):577-82. doi: 10.1007/BF01307582.
This study investigates the effect of a single dilation on the morphology of the lower esophageal ring and on the clinical course of symptomatic patients. Thirty-three patients were studied prospectively for a mean period of 24.3 +/- 19.2 months. Passage of a large bougie (46-58 F) resulted in a rupture of the ring in each instance and its mean diameter increased from 11.4 +/- 3.6 to 17.2 +/- 4.1 mm. No complications occurred, and all patients were symptom-free at the first follow-up examination four weeks after dilation. However, late symptomatic recurrences were frequent. After one year, the estimated proportion of patients remaining free of symptoms was 68% after two years 35%, and after five years 11%. Repeated treatments were performed with similar ease and effectiveness; again, no complications were encountered. Neither the initial ring size nor the presence or absence of esophagitis determined the likelihood of symptomatic recurrences. It is concluded that single dilations of symptomatic lower esophageal rings are safe, easily performed, and well tolerated. Long-term cure of episodic dysphagia is rare, but recurrences can be successfully treated by repeated dilations.
本研究调查了单次扩张对食管下括约肌环形态及有症状患者临床病程的影响。对33例患者进行了前瞻性研究，平均随访时间为24.3±19.2个月。每次使用大口径探条（46 - 58F）通过均导致括约肌环破裂，其平均直径从11.4±3.6毫米增加到17.2±4.1毫米。未发生并发症，所有患者在扩张后四周的首次随访检查时均无症状。然而，症状晚期复发很常见。一年后，估计无症状患者的比例为68%，两年后为35%，五年后为11%。重复治疗操作简便且效果相似；同样未出现并发症。初始括约肌环大小以及食管炎的有无均不能决定症状复发的可能性。结论是，对有症状的食管下括约肌环进行单次扩张是安全的，操作简便，耐受性良好。发作性吞咽困难的长期治愈很少见，但复发可通过重复扩张成功治疗。
