Objective To determine the effectiveness and safety of pneumatic balloon dilatation in patients with achalasia. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, issue 1, 2007), MEDLINE or PUBMED (1978-2007), Embase (1978-2007), OVID Database (1978-2007), Chinese Biological Medicine Database (CBMDisc, 1978-2007), CNKI (1979-2007), Chinese VIP Database (1989-2007) and Wanfang Database (1978-2007). We also checked the reference lists of retrieved articles and relevant proceedings. We used the methods recommended by The Cochrane Collaboration to conduct this systematic review. Results Twenty four trials involving 1045 patients were included. Meta-analyses showed that the short-term total effective rate was much higher with pneumatic dilatation than intrasphincteric botulinum toxin injection (P=0.0007). The long-term total effective rate was higher with pneumatic dilatation compared to intrasphincteric botulinum toxin injection (P=0.005). Intrasphincteric botulinum toxin injection was superior to pneumatic dilatation in terms of clinical relapse rate (Plt;0.0001). Our analyses of complications and adverse effects found that pneumatic dilatation was superior to intrasphincteric botulinum toxin injection (P=0.0008), and endoscopic sphincterotomy was superior to balloon dilatation (P=0.0006). Conclusions The limited current evidence shows that: pneumatic dilatation is safe and effective for the short- or long-term treatment of achalasia.
目的 探讨胆道术后肝内、外胆管狭窄的治疗方法。方法 回顾性分析吉林大学第一医院自2003年1月至2007年12月期间应用胆道镜对37例胆道术后肝内、外胆管狭窄患者行气囊扩张治疗的结果。结果 本组37例患者42处肝内、外胆管狭窄均行胆道镜下气囊导管扩张，29例（78.4%）系胆管狭窄伴肝内胆管结石，经气囊扩张后，胆道镜通过狭窄部位，取净远端胆管结石； 另8例（21.6%）系单纯胆管狭窄无结石,仅行导管扩张。本组成功率达97.3%（36/37）； 1例因胆汁性肝硬变伴弥漫性胆管狭窄扩张失败后行肝叶切除手术。27例狭窄仅需一次性扩张,9例因胆管多处严重狭窄而行多次扩张。全部患者均获随访，随访时间6~24个月,平均12个月，未见结石复发。结论 胆道镜下气囊导管扩张治疗胆管狭窄微创、直观、安全、简便易行且疗效可靠,是治疗胆管狭窄并取净结石的理想方法。但需注意操作方法及技巧，防止并发症的发生。