PREDICTORS OF OUTCOME IN PATIENTS WITH ACHALASIA TREATED BY PNEUMATIC DILATION
PREDICTORS OF OUTCOME IN PATIENTS WITH ACHALASIA TREATED BY PNEUMATIC DILATION
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DOI：
10.1016/0016-5085(92)91428-7
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发表时间：
1992-12-01
期刊：
影响因子：
29.4
通讯作者：
BERNHARD, G
中科院分区：
文献类型：
--
作者：
ECKARDT, VF;AIGNHERR, C;BERNHARD, G
这项前瞻性研究调查了气动扩张对贲门失弛缓症患者的影响是否可以根据患者特征、治疗类型或扩张后调查结果来预测。在10年的时间里，连续54例新诊断的贲门失弛缓症患者接受了气动扩张治疗，并进行了治疗前和治疗后的压力测量、x线摄影和影像学检查。他们每两年被跟踪调查一次，直到1991年秋天。在初始检查评估的因素中，只有年龄小对预后有不利影响（P< 0.05）。除扩张球囊直径外，治疗特征的预测价值较低。扩张后食管下括约肌压力是预测长期临床疗效的唯一最有价值的因素（P< 0.0005）。然而，高括约肌压力和治疗效果差的患者受益于反复扩张，其缓解期逐渐延长。结论：年轻患者不适合气动扩张，治疗应以扩张袋接近完全膨胀为目标，扩张后括约肌压力可指导进一步治疗。
This prospective study investigates whether the effect of pneumatic dilation in patients with achalasia can be predicted on the basis of patient characteristics, type of treatment, or results of postdilation investigations. Over a period of 10 years, 54 consecutive patients with newly diagnosed achalasia were treated with pneumatic dilation and underwent pretreatment and posttreatment manometric, radiographic, and scintigraphic investigations. They were followed up every 2 years until the fall of 1991. Among the factors evaluated in the initial examination, only young age adversely affected outcome (P< 0.05). With the exception of the diameter of the dilating balloon, the treatment characteristics had a low predictive value. Postdilation lower esophageal sphincter pressure was the single most valuable factor for predicting the long-term clinical response (P< 0.0005). However, patients with high sphincter pressures and poor treatment results benefited from repeated dilations by having progressively longer remissions. It is concluded that young patients are poor candidates for pneumatic dilation, that treatment should be aimed at near complete inflation of the dilating bag, and that postdilation sphincter pressure may guide further treatment.