大口径Rigiflex气囊序贯扩张治疗在贲门失驰缓症复发患者中的应用

摘要

[Objective] To evaluate the clinical efficacy and safety of endoscope-guided pneumatic sequential dilation with 3.5cm Rigiflex-ABD balloon catheter in patients with recurrent primary achalasia.[Methods] 27 cases of patient with recurrent primary achalasia were treated by pneumatic dilatation using endoscope,with a diameter of 3.5cm Rigiflex-ABD,the expanded pressure was 12-20Psi,each expansion of the duration of one minute,expanded twice or three times.Postoperative regular follow-up symptom score,esophageal barium meal examination,complications were analyzed compared with 43 cases accepted the diameter 3.2cm dumbbell-shaped balloon dilatation in treatment on patients with primary achalasia for the first time as clinical control.[Results] In terms of symptom relief,the long-term efficacy of the Rigiflex-ABD,balloon catheter group (6 months to 36 months) was higher than the dumbbell-shaped balloon catheter group,and the relief of symptoms for 12 months to 36 months after treatment was significantly higher than the dumbbell-shaped balloon catheter group.Follow-up esophageal barium meal examination after treatment,in the Rigiflex-ABD balloon catheter group (3 months to 36 months),the door of Ben's diameter was greater than the dumbbell-shaped balloon catheter,the 5 min' height of retention barium column less than the dumbbell-shaped balloon dilatation group,with statistically significant differences.The occurrence of esophageal bleeding,perforation and other complications were not found.[Conclusions] Sequential dilation with 3.5 cm diameter of the large-diameter Rigiflex balloon catheter in patients with recurrent achalasia has high security of treatment,significant long-term effect,titer prominent.In the current medical environment,it is one of the means of preferred safe,more cost-effective endoscopic treatment,thus worthy of clinical application.%目的 探讨内镜直视下采用3.5 cm Rigiflex-ABD气囊序贯扩张治疗原发性贲门失弛缓症复发患者的疗效及其安全性.方法 对27例复发的贲门失弛缓症患者在内镜直视下采用直径3.5 cm Rigiflex-ABD气囊扩张.扩张压力为12～20 Psi,每次扩张持续时间1min,扩张2、3次.术后定期随访症状积分、食管钡透检查、并发症等,与43例首次接受直径3.2 cm哑铃型气囊扩张治疗患者做临床对照.结果 在症状缓解方面,Rigiflex-ABD气囊组长期疗效(6～36个月)高于哑铃型气囊组,以治疗后12～36个月的症状缓解显著高于哑铃型气囊组.随访治疗后食管钡透检查,Rigiflex-ABD气囊组治疗后(3～36个月)贲门口直径大于哑铃型气囊组,5 min存留钡柱高度低于哑铃型气囊扩张组,差异有显著性.未出现食管大出血及穿孔等并发症.结论 选择3.5 cm直径的大口径Rigiflex气囊序贯扩张治疗复发的贲门失缓症患者,治疗安全性高,长期疗效显著,效价比突出,在目前医疗环境下,是一种首选的性价比高、安全、有效的内镜治疗手段之一,值得临床推广应用.