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目的比较胸腔镜辅助 Heller 手术、开胸 Heller 手术、消化内镜下球囊扩张及消化内镜下肉毒毒素注射治疗贲门失弛缓症疗效,探讨贲门失弛缓症合理有效的治疗方法。方法 81例贲门失弛缓症患者按不同治疗方式分为4组:胸腔镜辅助 Heller 手术18例;开胸 Heller 手术21例;消化内镜下球囊扩张22例;肉毒毒素注射治疗20例。比较各组治疗前后症状评分、食管末端直径、食管下段括约肌压力、食管末端 pH 和各组有效率。结果 4组患者治疗前后相比,症状评分、食管末端直径、食管下段括约肌压力、食管末端 pH 差异均有统计学意义(P<0.05),治疗有效率胸腔镜组为94.4%、开胸组为95.2%、球囊扩张组为63.6%、肉毒素注射组为55.0%,Heller 手术较消化内镜下治疗更为有效(P<0.05)。结论 Heller 手术治疗效果较球囊扩张及肉毒素注射为佳,胸腔镜辅助Heller 手术较开胸 Heller 手术具有创伤小、恢复快、住院时间短等优势。
Objective To compare the efficacy of thoracoscope-assisted heller surgery, thoracotomy Heller surgery, endoscopic balloon dilation and endoscopic digestion of botulinum toxin in the treatment of achalasia, and to explore a reasonable and effective treatment for achalasia. Methods Eighty - one patients with achalasia were divided into 4 groups according to different treatment methods: thoracoscope assisted Heller operation in 18 cases, thoracotomy Heller operation in 21 cases, digestive endoscopy balloon expansion in 22 cases and botulinum toxin injection in 20 cases. Symptom scores, esophageal distal diameter, esophageal sphincter pressure, esophageal distal pH and effective rate of each group were compared before and after treatment. Results There were significant differences in symptom scores, esophageal distal diameter, esophageal sphincter pressure and esophageal extremity pH between the 4 groups before and after treatment (P <0.05). The effective rate was 94.4% in thoracoscope group and 95.2% in the balloon group, 63.6% in the balloon group and 55.0% in the botulinum toxin group. The Heller operation was more effective than the digestive endoscopy group (P <0.05). Conclusions Heller operation is better than balloon dilation and botulinum toxin injection. The thoracoscope-assisted Heller operation is less traumatic, faster recovery and shorter hospitalization time than Heller operation.