食管—胃癌术后吻合口狭窄的激光切割扩张治疗（附48例报告）

DILATATION OF ANASTOMTIC STRICTURE BY Nd: YAG LASER BEAM UNDER ENDOSCOPY

对４８例食管及贲门癌术后并发吻合口狭窄患者，采用掺钕钇铝石榴石（简称Ｎｄ·ＹＡＧ）激光沿吻合口缘作分点气化切割治疗，获得满意疗效。其中食管癌术后狭窄２１例，贲门癌术后狭窄２０例，高位胃体癌术后狭窄６例，残胃癌术后狭窄１例。４８例中，作１次激光切割治疗者２５例，２次者１５例，３次者６例，４次者２例。经长期随访，胃镜复查，按疗效判定标准，获显效４１例（８５．４％），有效５例（１０．４％），无效２例（４．２％）。在１～１１／２年随访中，４例死于手术后复发，２例失访。作者强调，严格操作规程及熟练的内窥镜激光技术是避免出血、穿孔等并发症的关键。

Abstract Anastomotic stricture has become a common complication followlng surgical treatment of uppergastrointestinal cancers.A technique was devised to alleviate the stricture with Nd. YAG laser beamunder endoscopy. The laser beam was applied at 3～4 different points near the anastomotic stoma.The thermal effect of the beam would cut the scar tissues in and underneath the mucosa, leading todilatation of the stoma. A total of 48 patients with cancer of the esophagus(n=21), gastric cardia(n=20), body of stomach(n=6)and gastric stumpn=1) with postoperative anastomotic stricture wasso treated. According to the degree of dilatation, the result of treatment upon longterm follow-upwas good(the anastomotic stoma was enlarged more than 6 mm)in 41(85.4%),fair (the stoma enlarged 4～5 mm)in 5(10.4%) and poor in the remaining 2. Due precautions should be made to avoidbleeding and perforation.