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1 病例报告女,65岁,退休工人.5a 前无明显诱因出现咽下困难、烧心、反食等症状,曾在多个医疗单位行上消化道造影和内镜检查诊断为贲门失弛缓症(achalasia,AC),口服654-2、消心痛等药,症状曾一度稍好转,但不久即复发,再服药却无明显疗效,入我院前仅能咽下流食,时有反食和胸骨后疼痛.入院时查体除较消瘦及轻度贫血貌外,无其他阳性体征,食管造影显示食管缩短并呈明显扩张,造影剂潴留,贲门关闭上移使食管下端呈袖袋回缩样改变,呈袋样向外下突出,造影剂通过贲门困难,贲门下可见一半月状膈上疝囊.内镜见食管缩短并明显扩张,有中等量潴留物,食管粘膜呈慢性炎改变,贲门上移关闭,距门齿仅28 cm,内镜难以通过,贲门周围呈环周憩室样改变,于贲门周围3,6,9,12点钟位各注射肉毒毒素-A(BTXA,兰州生物制品研究所)20U(1 mL)至食管肌层.术后症状即明显改善,可顺利地进普通饮食,X 线复查示造影剂通过贲门顺利,食管内无造影剂潴留,但食管的形态及膈上疝囊无改变.随访3mo 无症
1 case report female, 65 years old, retired workers .5a no obvious incentive before swallowing difficulties, heartburn, anti-food and other symptoms, had multiple medical units on the digestive tract imaging and endoscopy diagnosis of achalasia achalasia, AC), oral administration of 654-2, anti-angina and other drugs, symptoms once slightly improved, but soon relapse, and then no significant effect of medication, into our hospital only swallowed the flow of food, sometimes anti-food and sternal Pain.Compared with emaciation and mild anemia, there was no other positive signs on admission except the esophageal angiography showed esophageal shortening and significant expansion, contrast retention, cardia close up to the esophageal sleeve was retracted to the bottom of the change, Showed a bag-like protruding to the outside, contrast agent through the cardia difficult, under the cardia can be seen half of the diaphragm on the diaphragm hernia sac. Esophageal shortening and significant expansion of the endoscopy, there was moderate amount of retention, esophageal mucosa was chronic inflammatory changes, cardiac shift Close, only 28 cm away from the incisors, endoscopy difficult to pass around the cardia was diverted around the ring-like changes in the cardia around the 3,6,9,12 o’clock position were injected botulinum-A (BTXA, Lanzhou Institute of Biological Products ) 20U (1 mL) to the esophageal muscle layer.After the symptoms were significantly improved, can smoothly into the general Through diet, X-ray examination showed that the contrast agent passed through the cardia successfully without estrogen retention in the esophagus, but there was no change in esophageal morphology and septal hernia sac.