【摘要】 目的 监测山莨菪碱肌注前后食管动力的变化，探讨其在假性贲门失弛症和贲门失弛症鉴别诊断中的价值。 方法 10例贲门失弛症和3例胃底贲门癌致假性贲门失弛症的患者，通过8通道袖套式测压导管持续观察食管动力在肌注山莨菪碱前后的变化。 结果 10例贲门失弛症患者在肌注山莨菪碱后下食管括约肌松弛程度达47.4%～74.0%，食管体部静息压明显降低;3例假性贲门失弛症患者食管括约肌松弛程度仅2.2%～8.8%，食管体部静息压亦无明显变化。 结论 山莨菪碱试验可作为贲门失弛症食管测压诊断时的重要补充，也是贲门失弛症和假性贲门失弛症鉴别诊断的手段之一。
【关键词】 食管失弛症; 山莨菪碱; 食管; 测压法
Anisodamine Test in Distinguishing Pseudoachalasia from Idiopathic Achalasia
ZHENG Wei, CHEN Chun, KANG Mingqiang, LIN Peiqiu, LIN Ruobai, CHEN Shuchen
Department of Thoracic Surgery, The Affiliated Union Hospital, Fujian Medical University, Fuzhou 350001, China
ABSTRACT: Objective To distinguish pseudoachalasia from idiopathic achalasia by esophageal manometry before and after intramuscular injection of anisodamine. Methods Ten patiens with idiopathic achalasia and 3 patients with cardia cancerinduced pseudoachalasia were selected in this study. An eightlumen manometric sleeve assembly was inserted through a nostril into the stomach. The sleeve was astride the lower esophageal sphincter. Esophageal manometry was performed with a polygraphic system (PC POLYGRAF HR) before and after intramuscular injection of anisodamine. Results In the group with idiopathic achalasia, the lower esophageal sphincter relaxation was 47.4% to 74.0% after intramuscular injection of anisodamine, and esophageal body resting pressure obviously decreased. In the group with pseudoachalasia, however, the lower esophageal sphincter relaxation was 2.2% to 8.8%, and there was no obvious change about esophageal body resting pressure. Conclusions Anisodamine test is a significant complement to diagnosing idiopathic achalasia by esophageal manometry, and may be an efficient method for distinguishing idiopathic achalasia from pseudoachalasia.
KEY WORDS: esophageal achalasia; ANISODAMINE; esophagus; manometry
假性贲门失弛症通过标准的X线、食管测压甚至内镜检查与贲门失弛症难以鉴别，食管远端或食管胃交界处原发恶性肿瘤是其主要原因[13]。2007年10月-2009年11月，笔者通过监测山莨菪碱肌注前后食管动力的变化，以探讨其在假性贲门失弛症和贲
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