目的:观察内镜下气囊扩张术(PD)治疗贵门失弛缓症(AC)的临床疗效、疗效影响因素和安全性.方法:在内镜下使用直径30 mm气囊扩张治疗贲门失弛缓症73例,行扩张97次,定期随访观察治疗前后患者临床症状及其缓解、复发和并发症,随访平均39.57(s 29.36)个月,使用Kaplan-Meier生存曲线、log-rank检验和Cox回归分析年龄、性别和扩张次数等因素对患者缓解及复发的影响.结果:患者临床症状得到有效缓解,中位缓解月数为62个月(s19.31,95％ CI24.15～99.85).患者临床症状的缓解和复发与年龄和扩张次数有关.术后有黏膜渗血(42.27％)、贲门黏膜撕裂(412％)、严重胸痛(2.06％)和胃食道返流痛(8.57％).未发生穿孔、呕血或黑使并发症.结论:内镜下气囊扩张术治疗贲门失弛缓症疗效满意、安全和经济.增加扩张次数可延长缓解时间.年轻患者缓解时间短,易复发.%Objective: To evaluate the long-term efficacy and safety of endoscopic pneumatic dilation (PD) for achalasia cardia (AC). Methods: A total of 73 patients with AC were treated with PD with 30 mm diameter during 2000 and 2009 for 97 times. They were followed at regular intervals for 39,57 months (s 29.36). Cumulative remission rate and predictors related to the remissions were analyzed by using the Kaplan-Meier survival curve, log-rank test and Cox ' s proportional hazard model. Results: During follow-up, the symptoms remitted in mosl of the 73 patients. The median symptom-free duration was 62 months (s 19.31, 95% CI24.15-99.85). Age and times of dilation were relevant predictors to the remissions. Some of patients were found to have oozing of blood, mucosal lacerations, chest pain and GERD after PD. None of patients had complications of perforation, haematemesis or melena. Conclusion: Endoscopic pneumatic dilatation with 30 nun diameter is an effective, safe and economic treatment for achalasia. The duration of remission can be extended by repeated dilations. Young patients have poorer outcomes following PD.
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