McJunkin B, McMillan W O, Duncan H E, Harman K M, White J J, McJunkin J E
Gastroenterology Section, Charleston Area Medical Center, West Virginia.
Gastrointest Endosc. 1991 Jan-Feb;37(1):18-21. doi: 10.1016/s0016-5107(91)70614-7.
In a retrospective study, 33 achalasia patients were treated with dilation therapy using large diameter mercury bougienage (mean, 56 French) and/or pneumatic balloon dilation. Mean follow-up time was 35 months. Mercury bougienage, performed in 20 patients, was successful in 10 (50%) with no complications. Pneumatic dilation was performed as initial therapy or in those having failed previous pharmacologic therapy and/or bougienage. A successful response was achieved in 19 of 23 patients (83%), with a 3.2% complication rate. In addition, in four patients with eventual recurrence of symptoms after initial pneumatic dilation, bougienage was used as a successful alternative to repeat pneumatic treatment. The combined efficacy of both forms of dilation was 88% with a complication rate of 1.4%. These data indicate that mercury bougienage should be considered initial therapy for achalasia in view of its simplicity, safety, and acceptable efficacy, followed by pneumatic dilation if bougienage is unsuccessful. Bougienage also may be considered if eventual recurrent symptoms develop after initially successful pneumatic dilation. Surgery should be utilized only if dilation therapy fails to achieve a satisfactory response.
在一项回顾性研究中，33例贲门失弛缓症患者接受了大直径汞柱探条扩张术（平均56法式）和/或气囊扩张治疗。平均随访时间为35个月。20例患者接受了汞柱探条扩张术，其中10例（50%）成功，无并发症。气囊扩张作为初始治疗或用于先前药物治疗和/或探条扩张失败的患者。23例患者中有19例（83%）获得成功反应，并发症发生率为3.2%。此外，在4例初次气囊扩张后最终症状复发的患者中，探条扩张术成功替代重复气囊治疗。两种扩张方式的联合有效率为88%，并发症发生率为1.4%。这些数据表明，鉴于汞柱探条扩张术操作简单、安全且疗效尚可，应将其视为贲门失弛缓症的初始治疗方法，若探条扩张术不成功则采用气囊扩张。如果初次气囊扩张成功后最终出现复发症状，也可考虑探条扩张术。仅在扩张治疗未能取得满意效果时才应采用手术治疗。
