CAJ | 학술논문

目的：探讨肝硬化门静脉高压症行贲门周围血管离断术后发生贲门失迟缓的诊治方法。方法：对我院2008年1月～2013年5月共行脾切除＋贲门周围血管离断术282例术后发生不同程度的贲门失迟缓的43例（15．2％）病例资料进行分析总结。结果：43例在术后出现进食梗咽感、吞咽困难，给予心理安慰、对症治疗缓解34例；另9例经鼻肠管给予肠内营养液、流质，4例缓解，余5例病人仍进食困难，进食后呕吐，行上消化道钡餐检查提示贲门线样狭窄，经内镜或介入球囊扩张治疗后缓解，其中4例经1次扩张后即缓解，1例经两次球囊扩张后缓解，目前随访中未发现症状反复。结论：门脉高压症断流术后贲门失迟缓与性别、断流位置高低、术前反复出血行腔内治疗、术中食管肌层的损伤及术中应用非吸收化学胶食管表面喷洒有一定的关系，本病应早发现早治疗，保守治疗不缓解，宜选用介入或内镜下食管球囊扩张治疗，疗效肯定。
목적：탐토간경화문정맥고압증행분문주위혈관리단술후발생분문실지완적진치방법。방법：대아원2008년1월～2013년5월공행비절제＋분문주위혈관리단술282례술후발생불동정도적분문실지완적43례（15．2％）병례자료진행분석총결。결과：43례재술후출현진식경인감、탄인곤난，급여심리안위、대증치료완해34례；령9례경비장관급여장내영양액、류질，4례완해，여5례병인잉진식곤난，진식후구토，행상소화도패찬검사제시분문선양협착，경내경혹개입구낭확장치료후완해，기중4례경1차확장후즉완해，1례경량차구낭확장후완해，목전수방중미발현증상반복。결론：문맥고압증단류술후분문실지완여성별、단류위치고저、술전반복출혈행강내치료、술중식관기층적손상급술중응용비흡수화학효식관표면분쇄유일정적관계，본병응조발현조치료，보수치료불완해，의선용개입혹내경하식관구낭확장치료，료효긍정。
Objective:To investigate the diagnosis and surgical approach to post operative achalasia after pericardial devasculatirzation in patients with por-tal hypertension resulted from liver cirrhosis.Methods:The clinical data were retrospectively examined in 43 of 282 patients undergone conventional sple-nectomy plus pericardial vessel devascularization complicated with post-oerative achalasia to a certain degree.Results: After operation,43 patients com-plained of catch sensation of food intake and dysphagia.By symptomatic treatment and psychological intervention,remission occurred in 34,and 9 were giv-en enteral nutrition via nasojejunal tube,in which 4 were relieved and 5 remained no remission.The clinical picture included vomiting after food intake due to thread-like stenosis of cardia by the findings of barium meal X-ray for the upper digestive tract.Endoscopic balloon dilation was applied to the 5 cases, and remission occurred in 4 by one intervention and in 1 by twice.No relapse occurred in the follow-up period.Conclusion:Esophageal stenosis after peri-cardial devascularization is closely associated with gender,devascularization position,preoperative intravascular interventional therapy of repeated bleeding, intraoperative esophagus muscular injury and spraying esophageal mucosal surface with non-absorbing chemical glue.Early detection and treatment should be necessary for this disease,and interventional treatment or endoscopic balloon dilation is effective and recommended to the failure of conservative treat-ment.