手术及非手术创伤后贲门失弛缓症

作     者：Shah R.N Izanec J.L Friedel D.M H.P.Parkman 李翔 

作者机构：Division of Gastro enterology Temple University Hospital Parkinson Pavilion 3401 North Broad Street PhiladelphiaPA 19140 United States.Dr 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2005年第1卷第8期

页      面：5-5页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：贲门失弛缓症 胃底折叠术 迷走神经损伤 肺移植术 上消化道 神经功能障碍 内窥镜检查 吞咽困难 机动车辆 胸痛 

摘      要：Achalasia has been described following fundoplication and is attributed to vag al nerve damage during surgery. Similarly,other traumatic events to the distal e sophagus may be linked to the development of achalasia. Operative and nonoperati ve trauma as a possible factor in the development of achalasia was studied. A re trospective analysis of patients with achalasia(n = 64) at our institution was p erformed. Collected data included age, gender, symptoms, and history of operativ e and nonoperative traumatic events. Comparisons were made to a group of patient s with similar symptoms but normal esophageal manometry (n = 73). Achalasia was diagnosed by manometry in 125 patients over a 6-year period. All patients with complete medical records (n = 64) were studied. A history of operative or nonope rative trauma to the upper gastrointestinal tract prior to the development of sy mptomatic achalasia was present in 16 of 64 (25%). Significantly fewer patients (9.5%) wi th symptoms of dysphagia, but normalmanometry and upper endoscopy, had precede nt trauma to the upper gastrointestinal tract (P 0.05).All cases of nonoperati ve trauma occurred in motor vehicle accidents. Cases of operative trauma include d coronary artery bypass surgery (n = 4), bariatric surgery (n = 2), fundoplicat ion(n = 3), hea rt/lung transplantation (n = 1), and others (n =5). Pa tients with proven achalasia and a history of trauma were more likely to have chest pain (RR, 4.5; P = 0.012) but less likely to have regurgitation (RR, 0.51; P = 0.01) or nausea/vomiting(RR, 0.0; P = 0.27) than those without a history of antecedent trauma. In this series, significantly more patients with achalasia h ad a history of preceding trauma than did patients with similar symptoms and nor mal esophageal manometry. Following trauma, patients may be at increased risk fo r developing achalasia, possibly from neuropathic dysfunction due to vagal nerve damage. Patients with posttraumatic achalasia may have symptoms wh