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改良型可回收金属支架治疗贲门失弛缓症疗效的初步探索

(2014-10-22 12:29:15)

    改良型可回收金属支架治疗贲门失弛缓症疗效的初步探索

    戴军  沈煜枫  李晓波 高云杰  宋燕  戈之铮

    资金项目:上海市重点学科建设项目资助( No.YO0205

    作者单位:200001上海,上海交通大学医学院附属仁济医院消化内科 上海市消化疾病研究所

    【摘要】   目的  初步探讨改良型可回收金属支架治疗贲门失弛缓症的疗效及安全性。方法 30例确诊为贲门失迟缓症患者随机分成二组,普通型支架(A组)和改良型支架(B组)各15例,在胃镜直视下置入支架于贲门处,2 d后在X线引导下通过胃镜将支架取出。分别记录治疗前及治疗半年后患者吞咽困难、LES静息压及食管X线表现(包括食管最扩张处直径、贲门最狭窄区宽度)的变化情况;支架置入时与2天后取出时X线下支架最狭窄处的宽度变化;治疗过程中不良反应及并发症情况。结果 30例支架置入和取出的成功率为100%,置入后A组有2例发生支架脱落,取出后重新置入,B组无一例出现移位和脱落。支架治疗半年后患者吞咽困难与治疗前相比二组均有明显改善(P<0.05);但半年后吞咽困难复发率A组(26.7%)明显高于B组(6.67%)(P<0.05);支架治疗前后X线下食管腔最大扩张程度二组均有明显改善 (P<0.001),贲门最狭窄区直径、支架放置后和取出时最狭窄处直径及LES静息压二组较治疗前均有明显改善,但改善程度B组显著优于A (P<0.05)。治疗时及治疗后不良反应发生率二组无统计学差异,二组均无穿孔。结论 改良型可回收金属支架治疗贲门失弛缓症具有放置时间短、无移位脱落、症状改善明显及复发率低等优点,且安全性良好。

    【关键词】贲门失弛缓症;可回收金属支架,食管扩张术

    Efficacy of implantation of a modified temporary metallic stent for cardia achalasia  DAI Jun, SHEN Yu-feng, LI Xiaobo, GAO Yun-jie, SONG Yan, GE Zhi-zheng. Department of Gastroenterology,Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China

    Corresponding author: GE Zhi-zhengEmailzhizhengge@yahoo.com.cn

    Abstract Objective: To study the efficacy and safety of implantation of a modified temporary self-expanding metallic stent for cardia achalasia. MethodA total of 30 patients diagnosed as having cardia achalasia were randomly divided into 2 groups, group A (traditional stents) and group B (modified stents)(n=15 ineach group). Two days after stent implantation at the cardia by endoscopy, stents were withdrawn with endoscope guided by X-ray. LES Pressure, X-ray images (including the diameter of the most dilated part of esophageal and the most narrow part of cardia) and the symptoms of dysphagia were compared before and half year after the treatment. The width changes of the most narrow stenting part on the point of stenting and 2 days after removal were compared. The side effects and complications during the treatment were recorded. ResultAll thirty stents were successfully implanted and removed. Stent dislocation occured in 2 cases in group A, but none in group B. Dysphagia had significant improvement after the treatment in both groups (P<0.05), but the recurrence rate of group A (26.7%) was significantly higher than group B (6.67%) in 6 months (P<0.05). LES pressure and X-ray images of both groups significantly improved after treatment (P<0.001), and those of group B were superior to group A (P<0.05). There was no difference in adverse reaction between the two groups. No perforation occured in any group. ConclusionSelf-expanding metallic stents is safe for patients with cardia achalasia, with implantation convenience, symptomatic improvement, low recurrence,  and few complications or dislocation.

    Key words cardia achalasia; temporary metallic stent; diatation of esophagus

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个人资料
    戈之铮 单位:上海交通大学医学院附属仁济医院
    所属科室:消化内科
    出生:1964-03-10
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