内镜下扩张术治疗食管静脉曲张硬化剂注射后食管狭窄的有效性和安全性

Efficacy and safety of endoscopic dilation in treatment of esophageal stenosis after sclerotherapy for esophageal varices

摘要:

目的 探讨内镜下扩张术治疗食管静脉曲张硬化剂注射后食管狭窄的有效性和安全性。方法 回顾性分析2014年1月－2023年12月该中心收治的17例因食管静脉曲张行内镜下硬化剂注射（EIS）治疗后继发食管狭窄的患者的临床资料，分为球囊扩张组和探条扩张组。观察内镜下扩张治疗后狭窄缓解率、复发率，以及术中出血、穿孔、感染和胸痛等并发症发生率。结果 17例患者共进行了50次内镜下扩张治疗，首次扩张治疗后狭窄缓解率为76.47%，复发率为53.85%。食管狭窄完全缓解共需扩张次数为1～15次，中位所需扩张次数为2次。其中，35.29%（6/17）只需1次扩张即可完全缓解。术中有4.00%（2/50）发生撕裂出血，需内镜干预止血，术后6.00%（3/50）出现发热，2.00%（1/50）出现胸痛，无穿孔和纵隔感染等其他并发症发生。球囊扩张组缓解率高于探条扩张组，差异有统计学意义（P < 0.05）；两组患者复发率和并发症发生率比较，差异均无统计学意义（P > 0.05）。结论 内镜下扩张术治疗食管静脉曲张硬化剂注射后食管狭窄安全且有效，在狭窄缓解方面，球囊扩张优于探条扩张。

Abstract:

Objective To investigate the efficacy and safety of endoscopic dilatation in treatment of esophageal stenosis after esophageal varices sclerotherapy.Methods Clinical data of 17 patients with esophageal stenosis after sclerotherapy for esophageal varices from January 2014 to December 2023 were retrospectively analyzed, and they were divided into balloon expansion group and bougie expansion group. The remission rate and recurrence rate of esophageal stenosis after endoscopic dilation were analyzed, as well as the incidence of intraoperative complications such as intraoperative bleeding, perforation, infection and chest pain.Results 50 endoscopic dilation treatments were performed in 17 patients. The stenosis remission rate after the first dilation was 76.47%, and the recurrence rate was 53.85%. The total number of dilation required for complete remission of esophageal stenosis ranged from 1 to 15 times, and the median required dilation was 2 times, and 35.29% (6/17) only needed 1 dilation to complete remission. Intraoperative laceration bleeding occurred in 4.00% (2/50) requiring endoscopic hemostasis. Fever occurred in 6.00% (3/50), chest pain occurred in 2.00% (1/50), and no other complications such as perforation and mediastinal infection occurred. The relief rate of balloon dilatation was higher than that of bougiate dilatation, and the difference was statistically significant (P < 0.05). There were no significant differences in recurrence rate and complication rate between the two groups (P > 0.05).Conclusion Endoscopic dilatation is generally safe and effective in the treatment of esophageal stenosis after sclerotherapy for esophageal varices, and balloon dilatation is superior to bougiate dilatation in the relief of stenosis.