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目的总结继发性贲门失弛缓症临床特征及误诊原因。方法经计算机选取2000-2012年本院确诊的贲门失弛缓症患者149例,其中5例为继发性贲门失弛缓症,观察症状持续时间;钡餐下食管形态学改变,包括食管最大宽度及狭窄长度变化;胃镜下贲门黏膜改变;食管下段压力变化,CT检查结果。结果本组继发性贲门失驰缓症平均年龄(54.0±23.7)岁,症状持续时间平均(4.6±0.7)个月,检查显示食管贲门狭窄长度平均(3.80±0.26)cm,食管最大径平均(4.32±0.64)cm,食管下端括约肌测压(LES)检查平均(40.50±0.70)cm H_2O,CT检查提示食管下段贲门及纵隔占位,手术探查病理证实胃黏液腺癌1例,贲门腺癌2例,食管下段鳞状细胞癌1例,纵隔型肺腺癌1例。结论继发性贲门失弛缓症少见,临床诊断中多存在误诊,延误治疗,应根据患者资料全面认真分析,做出正确判断。
Objective To summarize the clinical features and causes of misdiagnosis of secondary cardiac achalasia. Methods A total of 149 patients with achalasia diagnosed in our hospital from 2000 to 2012 were selected by computer. Among them, 5 were secondary to achalasia and the duration of symptoms was observed. The morphological changes of esophagus under barium diet, including the maximum esophageal width and stenosis Length changes; gastric cardia mucosa changes; lower esophageal pressure changes, CT examination results. Results The average age of secondary cardia deformity was 54.0 ± 23.7 years and the mean duration of symptoms was 4.6 ± 0.7 months. The average length of esophageal and gastric cardia stenosis was (3.80 ± 0.26) cm, the average esophageal maximum diameter (4.32 ± 0.64) cm, and the mean esophageal sphincter pressure (LES) was (40.50 ± 0.70) cm H_2O. The CT scan showed that the cardia and mediastinum were located in the lower esophagus. Surgical exploration confirmed gastric mucinous adenocarcinoma in 1 case and gastric cardia adenocarcinoma 2 cases, 1 case of esophageal squamous cell carcinoma and 1 case of mediastinal adenocarcinoma. Conclusions Secondary achalasia is uncommon. There are many misdiagnosis and delayed treatment in clinical diagnosis. Comprehensive and careful analysis should be based on the patient data to make correct judgment.