Molina E G, Stollman N, Grauer L, Reiner D K, Barkin J S
Division of Gastroenterology, University of Miami, School of Medicine/Mt. Sinai Medical Center, Florida 33140, USA.
Am J Gastroenterol. 1996 Jan;91(1):15-8.
We sought to determine the incidence and outcome with conservative management of esophageal nontransmural tears after pneumatic dilation for achalasia.
Retrospective review of 50 pneumatic balloon dilations in 30 patients with achalasia was performed at one center over an 18-month period.
Forty-four of 50 procedures (88%) were performed without complication. Two patients (4%) developed transmural perforations requiring immediate surgical repair; both recovered uneventfully. Four patients (8%) were found to have linear mucosal tears on routine postprocedure esophagrams. One patient was asymptomatic, and three had chest pain. No patient had fever. These four patients were managed conservatively with in-hospital observation for a mean of 4.3 days (range 3-6): nothing by mouth for a mean of 1.3 days (range 1-2) and i.v. antibiotics for a mean of 3 days (range 2-5). All were discharged within 6 days and were asymptomatic and tolerating a regular diet.
Esophageal nontransmural tears are not uncommon after pneumatic dilation for achalasia and can be safely treated with conservative medical management.
我们试图确定贲门失弛缓症经皮球囊扩张术后食管非全层撕裂的发生率及保守治疗的效果。
在一个中心对30例贲门失弛缓症患者进行的50次经皮球囊扩张术进行了为期18个月的回顾性研究。
50例手术中有44例（88%）未发生并发症。2例患者（4%）发生全层穿孔，需要立即进行手术修复；二者均顺利康复。4例患者（8%）在术后常规食管造影检查时发现有线性黏膜撕裂。1例患者无症状，3例有胸痛。无患者发热。这4例患者采用保守治疗，住院观察平均4.3天（范围3 - 6天）：平均禁食1.3天（范围1 - 2天），静脉使用抗生素平均3天（范围2 - 5天）。所有患者均在6天内出院，无症状，能耐受正常饮食。
贲门失弛缓症经皮球囊扩张术后食管非全层撕裂并不少见，采用保守药物治疗可安全治愈。
