球囊扩张治疗食管吻合口良性狭窄的疗效及安全性

The effectiveness and safety of endoscopic balloon dilation treatment of esophageal benign anastomotic stricture

摘要:

目的 分析内镜下球囊扩张治疗食管术后吻合口良性狭窄的有效性、安全性及吻合口狭窄程度对球囊扩张效果的影响。 方法 回顾性分析大连医科大学附属第一医院2006年3月～2013年1月因食管癌和（或）贲门癌行手术治疗后出现吻合口良性狭窄的47例患者，对患者术后出现吞咽困难的时间、程度、球囊扩张次数及并发症等项目分析。 结果 47例患者中2例患者由于重度瘢痕狭窄而造成吻合口闭塞，无法放入导丝进行扩张治疗。余45例患者中，治愈率为57.78%，有效率100%，且吻合口轻度狭窄组患者的治愈率较中度及重度狭窄组高，而中度组及重度组患者治愈率的差异未见明显统计学意义。吻合口轻度、中度、重度狭窄组患者球囊扩张1-3次治愈率分别为69.2%、17.6%、6.7%，扩张治疗6次及以上的治愈率分别为92.3%、52.9%、33.3%。47例患者扩张术后均未出现大出血、穿孔等严重并发症。其中23例患者扩张后出现胸骨后疼痛，7例患者出现烧心感，未予特殊处理，上述症状均可自行缓解。 结论 内镜下球囊扩张治疗食管术后吻合口良性狭窄的临床疗效确切且安全，狭窄出现早期行球囊扩张效果更佳。

Abstract:

【Objective】 To analyze the effectiveness and security of endoscopic balloon dilation treatment of benign esophageal anastomotic stricture, as well as the effect of balloon expansion degree on anastomotic stenosis . 【Methods】 47 patients who had benign anastomotic stenosis after surgeries because of esophageal cancer and/or cardia cancer were retrospectively analyzed from March 2006 to January 2013, the degree, cure rate of balloon dilation and the complications were analyzed. 【Results】 Two patients didn't have expansion treatment because of severe scar stenosis. The other 45 cases' cure rate was 57.78% and the effective rate was 100%. The cure rate of slight stenosis group was a higher than the moderate group and the severe group, while the cure rate between moderate group and severe group was no obvious difference. The 1-3 times of expansion cure rate of the 3 groups was 69.2%, 17.6%, 6.7%, respectively. The cure rate of more than 6 times for the 3 groups was 92.3%, 52.9%, 33.3%, respectively. There was no one who had serious complication such as postoperative bleeding and perforation, while 23 cases of 45 had retrosternal pain and 7 cases had heartburn, but the 30 patients alleviated without special treatment. 【Conclusion】 Endoscopic of balloon dilation is effective and safe to treat esophageal benign anastomotic stricture. It will have a good curative effect if being treated by balloon dilation as early as possible.