小探头超声内镜定位下小切开联合球囊扩张术治疗难治性食管良性狭窄的临床价值

Preliminary clinical study of miniprobe echoendoscope combined with balloon dilation in the treatment of refractory benign esophageal stenosis

摘要:

目的 探讨小探头超声内镜定位下小切开联合球囊扩张术治疗难治性食管良性狭窄的临床价值。方法 选择2019年10月－2023年10月该院收治的食管早癌经内镜黏膜下剥离术（ESD）后出现食管瘢痕狭窄的患者30例，随机分为研究组（小探头超声内镜定位下小切开 + 球囊扩张术）和对照组［食管放射状切开术（ERI）］，各15例。研究组术前采用超声内镜对食管壁层次结构进行判断，排除食管癌复发且呈黏膜下层以下浸润性生长表现者，依据小探头超声内镜明确的瘢痕段长度、瘢痕环管腔范围、预切开部位和长度，再换球囊行逐级扩张。观察两组患者术后短期并发症、Stooler吞咽困难分级量表评分和再狭窄率之间的差异，评估其可行性、安全性和疗效。结果 研究组术后短期并发症发生率为6.7%，明显低于对照组的46.7%，差异有统计学意义（P < 0.05）；研究组术后1和2个月的Stooler吞咽困难分级量表评分为（1.133±0.990）和（1.600±0.737）分，明显低于对照组的（2.067±1.033）和（2.467±0.915）分，差异均有统计学意义（P < 0.05）；术后2个月复查，研究组再狭窄率为13.3%，明显低于对照组的46.7%，差异有统计学意义（P < 0.05）；小探头超声内镜下瘢痕厚度为（2.113±0.887）mm，较对照组的（3.353±1.468）mm薄，差异有统计学意义（P < 0.05）。结论 术前联合小探头超声内镜评估，可精准定位病灶，内镜下小切开联合球囊机械扩张术治疗难治性食管良性狭窄，患者痛苦小，术后并发症少，且安全、有效。

Abstract:

Objective To explore the clinical value of mini-incision combined with balloon dilatation under the guidance of miniprobe echoendoscope in the treatment of refractory benign esophageal stenosis.Methods From October 2019 to October 2023, 30 cases of esophageal early cancer with esophageal scar stenosis after endoscopic submucosal dissection (ESD) were selected and randomly divided into study group (miniprobe echoendoscope guided small incision + balloon dilatation, 15 cases) and control group [esophageal radial incision (ERI), 15 cases], EUS in the study group judged the hierarchical structure of esophageal wall before operation, and excluded those with esophageal cancer recurrence and submucosal invasive growth. According to miniprobe echoendoscope, the length of scar segment and the scope of scar ring lumen were defined, and the location and length of pre-incision were defined, and then balloon was used to expand step by step. The short-term postoperative complications, Stooler dysphagia scale score and restenosis rate of the two groups were observed, and the feasibility, safety and efficacy were evaluated.Results The incidence of short-term postoperative complications 6.7% in the study group was significantly lower than that 46.7% in the control group, the difference was statistically significant (P < 0.05), and the Stooler dysphagia scale score were (1.133 ± 0.990) and (1.600 ± 0.737) in the study group at 1 and 2 months after operation with significantly lower than those (2.067 ± 1.033) and (2.467 ± 0.915) in the control group, the differences were statistically significant (P < 0.05). Two months after operation, the restenosis rate was 13.3%, which was significantly lower than that 46.7% of the control group, the difference was statistically significant (P < 0.05), and the scar thickness under miniprobe echoendoscope (2.113 ± 0.887) mm was significantly thinner than that (3.353 ± 1.468) mm of the control group, the difference was statistically significant (P < 0.05).Conclusion Preoperative miniprobe echoendoscope evaluation, can accurately locate lesions, endoscopic mini-incision combined with balloon mechanical expansion are safe and effective, with less pain and fewer postoperative complication.