一例賁門失弛緩癥患者的循證治療_《中國循證醫學雜志》

作者：

 劉啟勝 ^1,2 , 董衛國 ²

1. 咸寧市中心醫院消化內科（咸寧 437100）；2. 武漢大學人民醫院消化內科（武漢 430060）;

關鍵詞：

賁門失弛緩癥循證治療

DOI：

10.7507/1672-2531.20120076

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　借助循證醫學方法為1例賁門失弛緩癥患者確定治療方案。
方法　在評估患者情況后針對該例患者情況提出臨床問題，通過計算機檢索Cochrane 圖書館（1990～2010）、PubMed（1980～2010），查找并評價賁門失弛緩癥治療相關的最佳臨床證據。
結果　共檢索到33篇文獻，包括29個隨機對照試驗和4個系統評價，其對藥物治療、內鏡下肉毒桿菌注射、內鏡下球囊擴張治療和外科治療賁門失弛緩癥的療效和安全性進行了評價。我們結合患者的癥狀、年齡、合并疾病情況，向患者推薦內鏡下球囊擴張治療或經腹腔鏡行Heller術后加Dor胃底折疊術。患者最終選擇內鏡下球囊擴張治療，術后患者癥狀明顯好轉。
結論　采用循證治療方法，為賁門失弛緩癥患者確定合理的治療方案，不僅可有效提高治療效果，同時有利于引導醫患雙方共同承擔不確定的風險。

引用本文： 劉啟勝,董衛國. 一例賁門失弛緩癥患者的循證治療. 中國循證醫學雜志, 2012, 12(4): 489-494. doi: 10.7507/1672-2531.20120076 復制

1.	Sonnenberg A. Hospitalization for achalasia in the United States 1997-2006. Dig Dis Sci, 2009, 54(8): 1680-1685.
2.	Wen ZH, Gardener E, Wang YP.Nitrates for achalasia. Cochrane Database Syst Rev, 2004(1): CD002299.
3.	Nasrallah SM, Tommaso CL, Singleton RT, et al. Primary esophageal motor disorders: clinical response to nifedipine. South Med J, 1985, 78(3): 312-315.
4.	Traube M, Dubovik S, Lange RC, et al. The role of nifedipine therapy in achalasia: results of a randomized, double-blind, placebo-controlled study. Am J Gastroenterol, 1989, 84(10): 1259-1562.
5.	Bortolotti M, Mari C, Lopilato C, et al. Effects of sildenafil on esophageal motility of patients with idiopathic achalasia. Gastroenterology, 2000, 118(2): 253-257.
6.	Pasricha PJ, Ravich WJ, Hendrix TR, et al. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med, 1995, 332(12): 774-778.
7.	Kolbasnik J, Waterfall WE, Fachnie B, et al. Long-term efficacy of Botulinum toxin in classical achalasia: a prospective study. Am J Gastroenterol, 1999, 94(12): 3434-3439.
8.	D’Onofrio V, Annese V, Miletto P, et al. Long-term follow-up of achalasia patients treated with botulinum toxin. Dig Liver Dis, 2002, 34(2): 105-110.
9.	Muehldorfer SM, Hahn EG, Ell C. High- and low-compliance balloon dilators in patients with achalasia: a randomized prospective comparative trial. Gastrointest Endosc, 1996, 44(4): 398-403.
10.	Gideon RM, Castell DO, Yarze J. Prospective randomized comparison of pneumatic dilatation technique in patients with idiopathic achalasia. Dig Dis Sci, 1999, 44(9): 1853-1857.
11.	Mikaeli J, Fazel A, Montazeri G, et al. Randomized controlled trial comparing botulinum toxin injection to pneumatic dilatation for the treatment of achalasia. Aliment Pharmacol Ther, 2001, 15(9): 1389-1396.
12.	Falkenback D, Johansson J, Oberg S, et al. Heller’s esophagomyotomy with or without a 360 degrees floppy Nissen fundoplication for achalasia. Long-term results from a prospective randomized study. Dis Esophagus, 2003. 16(4): 284-290.
13.	Richards WO, Torquati A, Holzman MD, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg, 2004, 240(3): 405-412; discussion 412-415.
14.	Ramacciato G, Mercantini P, Amodio PM, et al. The laparoscopic approach with antireflux surgery is superior to the thoracoscopic approach for the treatment of esophageal achalasia. Experience of a single surgical unit. Surg Endosc, 2002, 16(10): 1431-1437.
15.	Patti MG, Arcerito M, De Pinto M, et al. Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. J Gastrointest Surg, 1998, 2(6): 561-566.
16.	Mikaeli J, Yaghoobi M, Montazeri G, et al. Efficacy of botulinum toxin injection before pneumatic dilatation in patients with idiopathic achalasia. Dis Esophagus, 2004, 17(3): 213-217.
17.	Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg, 2009, 249(1): 45-57.
18.	Wang L, Li YM, Li L. Meta-analysis of randomized and controlled treatment trials for achalasia. Dig Dis Sci, 2009, 54(11): 2303-2311.
19.	Wang L, Li YM, Li L, et al. A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia. World J Gastroenterol, 2008, 14(38): 5900-5906.
20.	Karanicolas PJ, Smith SE, Inculet RI, et al. The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia. Surg Endosc, 2007, 21(7): 1198-1206.
21.	Kostic S, Johnsson E, Kjellin A, et al. Health economic evaluation of therapeutic strategies in patients with idiopathic achalasia: results of a randomized trial comparing pneumatic dilatation with laparoscopic cardiomyotomy. Surg Endosc, 2007, 21(7): 1184-1189.
22.	Imperiale TF, O’Connor JB, Vaezi MF, et al. A cost-minimization analysis of alternative treatment strategies for achalasia. Am J Gastroenterol, 2000, 95(10): 2737-2745.

1. Sonnenberg A. Hospitalization for achalasia in the United States 1997-2006. Dig Dis Sci, 2009, 54(8): 1680-1685.
2. Wen ZH, Gardener E, Wang YP.Nitrates for achalasia. Cochrane Database Syst Rev, 2004(1): CD002299.
3. Nasrallah SM, Tommaso CL, Singleton RT, et al. Primary esophageal motor disorders: clinical response to nifedipine. South Med J, 1985, 78(3): 312-315.
4. Traube M, Dubovik S, Lange RC, et al. The role of nifedipine therapy in achalasia: results of a randomized, double-blind, placebo-controlled study. Am J Gastroenterol, 1989, 84(10): 1259-1562.
5. Bortolotti M, Mari C, Lopilato C, et al. Effects of sildenafil on esophageal motility of patients with idiopathic achalasia. Gastroenterology, 2000, 118(2): 253-257.
6. Pasricha PJ, Ravich WJ, Hendrix TR, et al. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med, 1995, 332(12): 774-778.
7. Kolbasnik J, Waterfall WE, Fachnie B, et al. Long-term efficacy of Botulinum toxin in classical achalasia: a prospective study. Am J Gastroenterol, 1999, 94(12): 3434-3439.
8. D’Onofrio V, Annese V, Miletto P, et al. Long-term follow-up of achalasia patients treated with botulinum toxin. Dig Liver Dis, 2002, 34(2): 105-110.
9. Muehldorfer SM, Hahn EG, Ell C. High- and low-compliance balloon dilators in patients with achalasia: a randomized prospective comparative trial. Gastrointest Endosc, 1996, 44(4): 398-403.
10. Gideon RM, Castell DO, Yarze J. Prospective randomized comparison of pneumatic dilatation technique in patients with idiopathic achalasia. Dig Dis Sci, 1999, 44(9): 1853-1857.
11. Mikaeli J, Fazel A, Montazeri G, et al. Randomized controlled trial comparing botulinum toxin injection to pneumatic dilatation for the treatment of achalasia. Aliment Pharmacol Ther, 2001, 15(9): 1389-1396.
12. Falkenback D, Johansson J, Oberg S, et al. Heller’s esophagomyotomy with or without a 360 degrees floppy Nissen fundoplication for achalasia. Long-term results from a prospective randomized study. Dis Esophagus, 2003. 16(4): 284-290.
13. Richards WO, Torquati A, Holzman MD, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg, 2004, 240(3): 405-412; discussion 412-415.
14. Ramacciato G, Mercantini P, Amodio PM, et al. The laparoscopic approach with antireflux surgery is superior to the thoracoscopic approach for the treatment of esophageal achalasia. Experience of a single surgical unit. Surg Endosc, 2002, 16(10): 1431-1437.
15. Patti MG, Arcerito M, De Pinto M, et al. Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. J Gastrointest Surg, 1998, 2(6): 561-566.
16. Mikaeli J, Yaghoobi M, Montazeri G, et al. Efficacy of botulinum toxin injection before pneumatic dilatation in patients with idiopathic achalasia. Dis Esophagus, 2004, 17(3): 213-217.
17. Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg, 2009, 249(1): 45-57.
18. Wang L, Li YM, Li L. Meta-analysis of randomized and controlled treatment trials for achalasia. Dig Dis Sci, 2009, 54(11): 2303-2311.
19. Wang L, Li YM, Li L, et al. A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia. World J Gastroenterol, 2008, 14(38): 5900-5906.
20. Karanicolas PJ, Smith SE, Inculet RI, et al. The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia. Surg Endosc, 2007, 21(7): 1198-1206.
21. Kostic S, Johnsson E, Kjellin A, et al. Health economic evaluation of therapeutic strategies in patients with idiopathic achalasia: results of a randomized trial comparing pneumatic dilatation with laparoscopic cardiomyotomy. Surg Endosc, 2007, 21(7): 1184-1189.
22. Imperiale TF, O’Connor JB, Vaezi MF, et al. A cost-minimization analysis of alternative treatment strategies for achalasia. Am J Gastroenterol, 2000, 95(10): 2737-2745.

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