食管癌根治术后吻合口良性狭窄的内镜下扩张最佳持续时间探讨

Appropriate duration of endoscopic dilation for benign anastomotic strictures after esophagectomy

摘要:

目的 探讨食管癌根治术后吻合口良性狭窄的内镜下扩张最佳持续时间。方法 回顾性分析2010年1月－2019年8月45例行食管癌根治术后并发吻合口良性狭窄的患者的临床资料，根据各自的内镜下扩张持续时间分为1 min组（n = 14）、3 min组（n = 16）和5 min组（n = 15），比较3组的治疗有效性与安全性。结果 1 min组的中位总体食管通畅时间为2.35（1.00，6.83）个月，3 min组的中位总体食管通畅时间为6.05（3.08，12.00）个月，5 min组的中位总体食管通畅时间为5.60（3.40，12.00）个月，3组患者比较，差异有统计学意义（P < 0.05）；3 min组与5 min组的中位总体食管通畅时间与平均狭窄复发时间相似，但均较1 min组明显延长。3组患者狭窄复发率分别为78.57%、56.25%和60.00%。1 min组的平均狭窄复发时间为（2.03±1.28）个月，3 min组的平均狭窄复发时间为（3.72±1.78）个月，5 min组的平均狭窄复发时间为（3.98±1.60）个月，3组患者比较，差异有统计学意义（P < 0.05）。5 min组中3例患者发生狭窄部位肌层损伤，其他两组患者未发生肌层损伤（P < 0.05）。结论 对于食管癌根治术后吻合口良性狭窄，内镜下持续扩张3 min为最安全有效的扩张持续时间。

Abstract:

Objective To investigate the optimal duration of endoscopic dilation for benign anastomotic stenosis after radical resection of esophageal cancer.Methods Clinical data of 45 patients with benign anastomotic strictures after esophagectomy from January 2010 to August 2019 were retrospectively analyzed. According to the dilation time, patients were divided into 1-min group (n = 14), 3-min group (n = 16) and 5-min group (n = 15). The clinical effects and complications were compared among the three groups.Results The median overall dysphagia-free period was 2.35 (1.00, 6.83) months in the 1-min group, 6.05 (3.08, 12.00) months in the 3-min group and 5.60 (3.40, 12.00) months in the 5-min group (P < 0.05), the dysphagia-free periods in the 3-min and 5-min groups were longer than that in the 1-min group. The stricture recurrence rate was 78.57% in the 1-min group, 56.25% in the 3-min group and 60.00% in the 5-min group. For patients who developed stricture recurrence, the mean dysphagia-free periods were (2.03 ± 1.28) months in the 1-min group, (3.72 ± 1.78) months in the 3-min group and (3.98 ± 1.60) months in the 5-min group, respectively (P < 0.05). Muscle layer damage occurred in 3 patients in the 5-min group and in no patients in the other two groups (P < 0.05).Conclusion Three min was supposed to be a safe and effective dilation duration for benign anastomotic strictures after esophagectomy.