Abid S, Champion G, Richter J E, McElvein R, Slaughter R L, Koehler R E
Division of Gastroenterology, University of Alabama at Birmingham.
Am J Gastroenterol. 1994 Jul;89(7):979-85.
To conduct a retrospective analysis of one center's experience with treating achalasia over 4 yr with skilled gastroenterologists using primarily the Rigiflex balloon dilator and with a senior surgeon performing Heller myotomies.
Newly diagnosed cases of achalasia were identified by a computer search of hospital records. Charts were reviewed for the presence/severity of dysphagia, regurgitation, heartburn, and chest pain. Weight loss was also recorded. Esophageal manometries and barium swallows were reviewed. Choice of treatment was made freely by patients. With an a priori definition of success, follow-up was conducted by telephone interviews.
A total of 45 achalasia patients (mean age, 46 yr; 32 females, 13 males) were identified with a symptoms-frequency as follows: dysphagia, 100%; regurgitation, 78%; heartburn, 50%; and chest pain, 42%. Mean weight loss was 17.5 pounds. Primary treatment was pneumatic dilation in 36 patients and surgery in nine patients. In a total of 45 pneumatic dilations, three (6.6%) were complicated by perforation. Five (14%) patients required repeat dilation. Mean duration of follow-up for pneumatic dilation and surgery was 27 months and 20.8 months, respectively. The overall excellent-good success rates were: pneumatic dilation 88% and surgery 89%. In comparing the efficacy of pneumatic dilation versus surgery, all symptoms were improved significantly (p < 0.01) in both groups, except heartburn, which increased postmyotomy.
If both procedures are available by skilled operators, pneumatic dilation and surgery are equally effective in the treatment of achalasia.
对一家中心4年来由熟练的胃肠病学家主要使用Rigiflex球囊扩张器以及由一名资深外科医生进行赫勒肌切开术治疗贲门失弛缓症的经验进行回顾性分析。
通过计算机检索医院记录来识别新诊断的贲门失弛缓症病例。查阅病历以了解吞咽困难、反流、烧心和胸痛的存在情况/严重程度。还记录体重减轻情况。回顾食管测压和钡餐检查结果。患者可自由选择治疗方法。根据事先定义的成功标准，通过电话访谈进行随访。
共识别出45例贲门失弛缓症患者（平均年龄46岁；女性32例，男性13例），症状出现频率如下：吞咽困难100%；反流78%；烧心50%；胸痛42%。平均体重减轻17.5磅。36例患者的初始治疗为气囊扩张，9例患者接受手术治疗。在总共45次气囊扩张中，3例（6.6%）发生穿孔并发症。5例（14%）患者需要重复扩张。气囊扩张和手术的平均随访时间分别为27个月和20.8个月。总体优良成功率分别为：气囊扩张88%，手术89%。比较气囊扩张与手术的疗效，两组所有症状均有显著改善（p<0.01），但烧心症状在肌切开术后有所增加。
如果熟练的操作人员都能开展这两种手术，气囊扩张和手术在治疗贲门失弛缓症方面同样有效。
