內鏡下氣囊擴張治療賁門失弛緩癥的系統評價_《中國循證醫學雜志》

作者：

何繼東 ¹ ,  王一平 ²

1. 雅安市第二人民醫院消化內科（四川雅安 625000）2. 四川大學華西醫院消化內科（成都 610041）;

關鍵詞：

賁門失弛緩癥內鏡下氣囊擴張治療系統評價 Meta分析

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目的　系統評價內鏡下氣囊擴張治療賁門失弛緩癥的有效性和安全性。
方法　計算機檢索Cochrane圖書館臨床對照試驗數據庫（2007年第1期）、MEDLINE（1978～2007年）、EMbase（1978～2007年）、OVID數據庫（1978~2007年）、中國生物醫學文獻數據庫（1978～2007年）、維普中文期刊數據庫（1989～2007年）、中國期刊全文數據庫（1979～2007年）和萬方學位論文數據庫（1978～2007年），手工檢索相關會議論文集及所獲文獻的參考文獻，全面收集全世界關于內鏡下氣囊擴張治療賁門失弛緩癥的隨機對照試驗。按Cochrane協作網推薦的方法進行系統評價。
結果　共納入24個RCT，包括1045例患者。Meta分析結果顯示：① 短期總有效率：內鏡下氣囊擴張治療優于內鏡下注射肉毒桿菌毒素治療［OR 0.47，95%CI（0.30，0.73）；P=0.0007］。② 長期總有效率：內鏡下氣囊擴張治療優于內鏡下注射肉毒桿菌毒素治療［OR 0.31，95%CI（0.13，0.70）；P=0.005］。③ 臨床復發率：內鏡下注射肉毒桿菌毒素治療高于內鏡下氣囊擴張治療［OR 8.88，95%CI（3.31，23.79）；P lt;0.0001］。④ 副作用及并發癥發生率：內鏡下氣囊擴張治療高于內鏡下注射肉毒桿菌毒素治療［OR 0.14，95%CI（0.04，0.44）； P=0.0008］；經腹開放性括約肌切開治療高于內鏡下氣囊擴張治療［OR 0.15， 95%CI（0.05，0.44）；P=0.0006］。
結論　目前的證據表明，內鏡下氣囊擴張治療具有較好的長短期療效，且操作簡單方便，不良反應少，建議在臨床實踐中依患者病情選用。

引用本文： 何繼東,王一平. 內鏡下氣囊擴張治療賁門失弛緩癥的系統評價. 中國循證醫學雜志, 2007, 07(7): 496-506. doi: 復制

1.	Qian F. Clinical study on intrasphincteric injection of botulinum toxin vs balloon dilation in the treatment of achalasia. Journal of Practical Diagnosis and therapy, 2006, 20(12): 908-909.
2.	Liu JY, Yang CM, Zhang AZ, et al. Clinical study on intrasphincteric injection of botulinum toxin and/or small balloon dilation in patients with esophageal achalasia. Chin J Dig Endosc, 2003, 20(3): 158-160.
3.	Jia DQ, Ouyang Q, Wang ZQ, et al. The value of pneumatic dilation in treament of esophageal achalasia. Chin J Dig Endosc, 2001, 18(6): 158-159.
4.	Yang ZW, Shao XY, Bu LX, et al. Clinical study on intrasphinctive injection of botulinum toxin A and balloon dilation in patients with esophageal achalasia. Chin J Dig Endosc, 2006, 12(7): 706-709.
5.	Cai FC, Liu QS, Guo RB, et al. The kinetic changes in esophageal achalasia treated by pneumatic dilation or intrasphincteric injection of botulinum toxin. Chin J Dig Endosc, 2003, 20(3): 161-163.
6.	Gui RH, Zheng XP, Leng JH, et al. Clinical study on intrasphinctive injection of botulinum toxin or small balloon dilation in patients with esophageal achalasia. Chinese Modern Medical and Clinical, 2006, 3(8): 31-32.
7.	Jin Y. The efficacy of patients with achalasia by intrasphincteric injection of botulinum toxin versus balloon dilation. Modern Medicine and Health, 2004, 20(17): 1728-1729.
8.	Yang CM, Liu JY, Liu QY, et al. Clinical study on intrasphincteric injection of botulinum toxin in the treatment of achalasia.ShanDong Medical Journal, 2002, 42(22): 1-2.
9.	Richter JE. Oesophageal motility disorders. Lancet, 2001, 358: 823-828.
10.	Streitz JM Jr, Ellis FH Jr, Gibb SP, et al. Achalasia and squamouscell carcinoma of the esophagus: analysis of 241 patients. Ann Thorac Surg, 1995, 59(6): 1604-1609.
11.	Meijssen MA, Tilanus HW, van Blankenstein M, et al. Achalasia complicated by oesophageal squamous cell carcinoma:a prospective study in 195 patients. Gut, 1992, 33(2): 155-158.
12.	Brucher BL, Stein HJ, Bartels H, et al. Achalasia and esophageal cancer: incidence, prevalence, and prognosis. World J Surg, 2001, 25(6): 745-749.
13.	Just-Viera JO, Haight C. Achalasia and carcinoma of the esophagus.Surg Gynecol Obstet, 1969, 128(5): 1081-1095.
14.	West RL, Hirsch DP, Bartelsman JF, et al. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol, 2002, 97(6): 1346-1351.
15.	Lehman MB, Clark SB, Ormsby AH, et al. Squamous mucosal alterations in esophagectomy specimens from patients with endstage achalasia. Am J Surg Pathol, 2001, 25(11): 1413-1418.
16.	Georgios Karamanolis, Spiros Sgouros, Georgios Karatzias, et al. Long-Term outcome of pneumatic dilation in the treatment of achalasia. Am J Gastroenterol, 2005, 100: 270-274.
17.	Society for Surgery of the Alimentary Tract (SSAT). Esophageal achalasia. Manchester (MA): Society for Surgery of the Alimentary Tract (SSAT); 2003. 3.
18.	Pasricha PJ, Ravich WJ, Hendrix TR, et al. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med, 1995, 322: 774-778.
19.	Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.4 [updated March 2005]. In: The Cochrane Library, Issue 2, 2005.
20.	Annese V, Bassotti G, Coccia G, et al. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. Gastroenterology, 1996, 111: 1418-1424.
21.	Des Varannes SB, Lemiere S,, Guillemot JF, et al. Botulinum toxin versus pneumatic dilatation in achalasia: results of a multicentre controlled trial. Esophageal, Gastric, and Duodenal Disorders, A129.
22.	Mikaeli J, Fazel A, Montazeri G. Randomized controlled trial comparing botulinum toxin injection to pneumatic dilatation for the treatment of achalasia. Aliment Pharmacol Ther, 2001, 15(9): 1389-1396.
23.	Bansal R, Nostrant TT, Scheiman JM, et al. Intrasphincteric botulinum toxin versus pneumatic balloon dilation for treatment of primary achalasia. J Clin Gastroenterol, 2003, 36(3): 209-214.
24.	Vaezi MF, Richter JE, Wilcox CM, et al. Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial. Gut, 1999, 44: 231-239.
25.	Ghoshal UC, Chaudhuri S, Pal BB, et al. Randomized controlled trial of intrasphincteric botulinum toxin A injection versus balloon dilatation in treatment of achalasia cardia. Dis Esophagus, 2001, 14: 227-231.
26.	Muehldorfer SM, Schneider TH, Hochberger J. Esophageal achalasia:intrasphincteric injection of botulinum toxin A versus balloon dilation. Endoscopy, 1999, 31(7): 517-521.
27.	蔡逢春, 劉慶森, 郭榮斌, 等. 氣囊擴張和肉毒桿菌毒素注射治療賁門失弛緩食管動力變化的比較. 中華消化內鏡雜志, 2003, 20(3): 161-163.
28.	桂若虎, 鄭新平, 冷建輝, 等. 經內鏡球囊擴張與肉毒堿注射治療賁門失弛緩癥的臨床研究. 中華現代醫學與臨床, 2006, 3(8): 31-32.
29.	金延. 內鏡下肉毒堿注射及氣囊擴張治療賁門失弛緩癥的療效分析. 現代醫藥衛生, 2004, 20(17): 1728-1729.
30.	楊崇美, 劉吉勇, 劉清英, 等. 內鏡下注射肉毒桿菌毒素治療賁門失弛緩癥的研究. 山東醫藥, 2002, 42(22): 1-2.
31.	錢峰. 氣囊擴張與肉毒桿菌毒素注射治療賁門失弛緩癥的療效分析. 實用診斷與治療雜志, 2006, 20(12): 908-909.
32.	劉吉勇, 楊崇美, 張安忠, 等. 氣囊擴張與肉毒桿菌毒素注射聯合治療賁門失弛緩癥的臨床研究. 中華消化內鏡雜志, 2003, 20(3): 158-160.
33.	Csendes A, Braghetto I, Henriquez A, et al. Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia. Gut, 1989, 30(3): 299-304.
34.	Csendes A, Velasco N, Braghetto I, et al. A prospective randomized study comparing forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus. Gastroenterology, 1981, 80(4): 789-795.
35.	賈道全, 歐陽欽, 王志強, 等. 內鏡下氣囊擴張治療賁門失弛緩癥的價值. 中華消化內鏡雜志, 2001, 18(6): 158-159.
36.	楊正武, 邵先玉, 卜令秀, 等. 氣囊擴張與肉毒桿菌毒素注射序貫聯合治療賁門失弛緩癥的臨床研究. 中國內鏡雜志, 2006, 12(7): 706-709.
37.	Gideon RM, Castell DO, Yarze J. Prospective randomized comparison of pneumatic dilatation technique in patients with Idiopathic achialasia. Digestive Diseases and Sciences, 1999, 44(9): 1853-1857.
38.	Alonso-Aguirre P, Aba-Garrote C, Estévez-Prieto E, et al. Treatment of achalasia with the Witzel dilator: a prospective randomized study of two methods. Endoscopy, 2003, 35(5): 379-382.
39.	F Mearin,, JR Armengol, L Chicharro, et al. Forceful dilatation under endoscopic control in the treatment of achalasia: a randomised trial of pneumatic versus metallic dilator. Gut, 1994, 35: 1360-1362.
40.	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.
41.	Stark GA, Castell DO, Richter JE, et al. Prospective randomized comparison of Brown-McHardy and microvasive balloon dilators in treatment of achalasia. Am J Gastroenterol, 1990, 85(10): 1322-1326.
42.	Becker K, Biesenbach S, Erckenbrecht JF, et al. Effect of balloon compliance on symptomatic success of pneumatic dilation in achalasia patients. Z Gastroenterol, 2001, 39: 831-836.
43.	Khan AA, Shah SW, Alam A, et al. Pneumatic balloon dilation in achalasia: a prospective comparison of balloon distention time. Am J Gastroenterol, 1998, 93(7): 1064-1067.
44.	Vaezi MF, Richter JE. Current therapies for achalasia: Comparison and efficacy. J Clin Gastroenterol, 1998, 27: 21-35.

1. Qian F. Clinical study on intrasphincteric injection of botulinum toxin vs balloon dilation in the treatment of achalasia. Journal of Practical Diagnosis and therapy, 2006, 20(12): 908-909.
2. Liu JY, Yang CM, Zhang AZ, et al. Clinical study on intrasphincteric injection of botulinum toxin and/or small balloon dilation in patients with esophageal achalasia. Chin J Dig Endosc, 2003, 20(3): 158-160.
3. Jia DQ, Ouyang Q, Wang ZQ, et al. The value of pneumatic dilation in treament of esophageal achalasia. Chin J Dig Endosc, 2001, 18(6): 158-159.
4. Yang ZW, Shao XY, Bu LX, et al. Clinical study on intrasphinctive injection of botulinum toxin A and balloon dilation in patients with esophageal achalasia. Chin J Dig Endosc, 2006, 12(7): 706-709.
5. Cai FC, Liu QS, Guo RB, et al. The kinetic changes in esophageal achalasia treated by pneumatic dilation or intrasphincteric injection of botulinum toxin. Chin J Dig Endosc, 2003, 20(3): 161-163.
6. Gui RH, Zheng XP, Leng JH, et al. Clinical study on intrasphinctive injection of botulinum toxin or small balloon dilation in patients with esophageal achalasia. Chinese Modern Medical and Clinical, 2006, 3(8): 31-32.
7. Jin Y. The efficacy of patients with achalasia by intrasphincteric injection of botulinum toxin versus balloon dilation. Modern Medicine and Health, 2004, 20(17): 1728-1729.
8. Yang CM, Liu JY, Liu QY, et al. Clinical study on intrasphincteric injection of botulinum toxin in the treatment of achalasia.ShanDong Medical Journal, 2002, 42(22): 1-2.
9. Richter JE. Oesophageal motility disorders. Lancet, 2001, 358: 823-828.
10. Streitz JM Jr, Ellis FH Jr, Gibb SP, et al. Achalasia and squamouscell carcinoma of the esophagus: analysis of 241 patients. Ann Thorac Surg, 1995, 59(6): 1604-1609.
11. Meijssen MA, Tilanus HW, van Blankenstein M, et al. Achalasia complicated by oesophageal squamous cell carcinoma:a prospective study in 195 patients. Gut, 1992, 33(2): 155-158.
12. Brucher BL, Stein HJ, Bartels H, et al. Achalasia and esophageal cancer: incidence, prevalence, and prognosis. World J Surg, 2001, 25(6): 745-749.
13. Just-Viera JO, Haight C. Achalasia and carcinoma of the esophagus.Surg Gynecol Obstet, 1969, 128(5): 1081-1095.
14. West RL, Hirsch DP, Bartelsman JF, et al. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol, 2002, 97(6): 1346-1351.
15. Lehman MB, Clark SB, Ormsby AH, et al. Squamous mucosal alterations in esophagectomy specimens from patients with endstage achalasia. Am J Surg Pathol, 2001, 25(11): 1413-1418.
16. Georgios Karamanolis, Spiros Sgouros, Georgios Karatzias, et al. Long-Term outcome of pneumatic dilation in the treatment of achalasia. Am J Gastroenterol, 2005, 100: 270-274.
17. Society for Surgery of the Alimentary Tract (SSAT). Esophageal achalasia. Manchester (MA): Society for Surgery of the Alimentary Tract (SSAT); 2003. 3.
18. Pasricha PJ, Ravich WJ, Hendrix TR, et al. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med, 1995, 322: 774-778.
19. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.4 [updated March 2005]. In: The Cochrane Library, Issue 2, 2005.
20. Annese V, Bassotti G, Coccia G, et al. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. Gastroenterology, 1996, 111: 1418-1424.
21. Des Varannes SB, Lemiere S,, Guillemot JF, et al. Botulinum toxin versus pneumatic dilatation in achalasia: results of a multicentre controlled trial. Esophageal, Gastric, and Duodenal Disorders, A129.
22. Mikaeli J, Fazel A, Montazeri G. Randomized controlled trial comparing botulinum toxin injection to pneumatic dilatation for the treatment of achalasia. Aliment Pharmacol Ther, 2001, 15(9): 1389-1396.
23. Bansal R, Nostrant TT, Scheiman JM, et al. Intrasphincteric botulinum toxin versus pneumatic balloon dilation for treatment of primary achalasia. J Clin Gastroenterol, 2003, 36(3): 209-214.
24. Vaezi MF, Richter JE, Wilcox CM, et al. Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial. Gut, 1999, 44: 231-239.
25. Ghoshal UC, Chaudhuri S, Pal BB, et al. Randomized controlled trial of intrasphincteric botulinum toxin A injection versus balloon dilatation in treatment of achalasia cardia. Dis Esophagus, 2001, 14: 227-231.
26. Muehldorfer SM, Schneider TH, Hochberger J. Esophageal achalasia:intrasphincteric injection of botulinum toxin A versus balloon dilation. Endoscopy, 1999, 31(7): 517-521.
27. 蔡逢春, 劉慶森, 郭榮斌, 等. 氣囊擴張和肉毒桿菌毒素注射治療賁門失弛緩食管動力變化的比較. 中華消化內鏡雜志, 2003, 20(3): 161-163.
28. 桂若虎, 鄭新平, 冷建輝, 等. 經內鏡球囊擴張與肉毒堿注射治療賁門失弛緩癥的臨床研究. 中華現代醫學與臨床, 2006, 3(8): 31-32.
29. 金延. 內鏡下肉毒堿注射及氣囊擴張治療賁門失弛緩癥的療效分析. 現代醫藥衛生, 2004, 20(17): 1728-1729.
30. 楊崇美, 劉吉勇, 劉清英, 等. 內鏡下注射肉毒桿菌毒素治療賁門失弛緩癥的研究. 山東醫藥, 2002, 42(22): 1-2.
31. 錢峰. 氣囊擴張與肉毒桿菌毒素注射治療賁門失弛緩癥的療效分析. 實用診斷與治療雜志, 2006, 20(12): 908-909.
32. 劉吉勇, 楊崇美, 張安忠, 等. 氣囊擴張與肉毒桿菌毒素注射聯合治療賁門失弛緩癥的臨床研究. 中華消化內鏡雜志, 2003, 20(3): 158-160.
33. Csendes A, Braghetto I, Henriquez A, et al. Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia. Gut, 1989, 30(3): 299-304.
34. Csendes A, Velasco N, Braghetto I, et al. A prospective randomized study comparing forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus. Gastroenterology, 1981, 80(4): 789-795.
35. 賈道全, 歐陽欽, 王志強, 等. 內鏡下氣囊擴張治療賁門失弛緩癥的價值. 中華消化內鏡雜志, 2001, 18(6): 158-159.
36. 楊正武, 邵先玉, 卜令秀, 等. 氣囊擴張與肉毒桿菌毒素注射序貫聯合治療賁門失弛緩癥的臨床研究. 中國內鏡雜志, 2006, 12(7): 706-709.
37. Gideon RM, Castell DO, Yarze J. Prospective randomized comparison of pneumatic dilatation technique in patients with Idiopathic achialasia. Digestive Diseases and Sciences, 1999, 44(9): 1853-1857.
38. Alonso-Aguirre P, Aba-Garrote C, Estévez-Prieto E, et al. Treatment of achalasia with the Witzel dilator: a prospective randomized study of two methods. Endoscopy, 2003, 35(5): 379-382.
39. F Mearin,, JR Armengol, L Chicharro, et al. Forceful dilatation under endoscopic control in the treatment of achalasia: a randomised trial of pneumatic versus metallic dilator. Gut, 1994, 35: 1360-1362.
40. 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.
41. Stark GA, Castell DO, Richter JE, et al. Prospective randomized comparison of Brown-McHardy and microvasive balloon dilators in treatment of achalasia. Am J Gastroenterol, 1990, 85(10): 1322-1326.
42. Becker K, Biesenbach S, Erckenbrecht JF, et al. Effect of balloon compliance on symptomatic success of pneumatic dilation in achalasia patients. Z Gastroenterol, 2001, 39: 831-836.
43. Khan AA, Shah SW, Alam A, et al. Pneumatic balloon dilation in achalasia: a prospective comparison of balloon distention time. Am J Gastroenterol, 1998, 93(7): 1064-1067.
44. Vaezi MF, Richter JE. Current therapies for achalasia: Comparison and efficacy. J Clin Gastroenterol, 1998, 27: 21-35.

《中國循證醫學雜志》

內鏡下氣囊擴張治療賁門失弛緩癥的系統評價

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《中國循證醫學雜志》

內鏡下氣囊擴張治療賁門失弛緩癥的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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