内镜直接扩张治疗消化性溃疡合并幽门梗阻

Treatment of pyloric obstruction with peptic ulcer by direct endoscopic dilatation

目的探讨消化性溃疡合并幽门梗阻的内镜简易疗法。方法经内镜活检孔放置塑料管和导丝,引导纤维胃镜的前端活动部,循腔强行推进内镜通过梗阻狭窄部,并向四周摆动直接扩张至周围粘膜轻度渗血,狭窄口扩大至10mm以上,内镜可进入十二指肠降部,术后按溃疡治疗3个月。结果 62例患者经过1～3次扩张后,显效43例(69.4％),有效12例(19.4％),总有效率为88.8％,随访1～5年无复发。结论内镜直接扩张治疗消化性溃疡合并的轻、中度幽门梗阻疗效良好。

Objective To find an easy way to treat peptic ulcer with pyloric obstruction by endoscope. Methods A plastic tube and a guide thread were put through the biopsy channel. They guided the movable head of fiberoptic gastroscope to forcibly press the strictured portion of obstruction along the lumen, and at the samc time to dilate thc stricture directly with a swing to all directions until the surrounding mucosa was slightly oozing. The strictured portion was at least 10mm in diameter after dilatation, and endoscope was advanced to the descending portion of the duodenum. A 3-month anti-ulcer treatment was followed after the dilatation. Resuits 62 patients received 1～3 times dilatations. 43 cases were obviously effective, 12 cases effective. The total cffect rate was 88.8%. No recurrence appeared in the follow-up period (1～5 years). Conclusion The curative effect is good by using endoscopic direct dilatation in treating peptic ulcer with slight, mid-grade pyloric obstruction.