家用便携式食管扩张器及家庭自助扩张法在食管狭窄治疗中的应用

Application of portable esophageal dilater in treatment of esophageal stenosis at home

目的：探讨适用于家庭自助的食管狭窄扩张方法和治疗效果。方法：应用自行设计并申请专利的“家用便携式食管扩张器”治疗67例食管狭窄患者，其中食管化学腐蚀伤29例，食管肿瘤术后23例，下咽后壁及食管上端肿瘤术后13例，喉癌甲状腺癌复发侵犯食管术后狭窄2例。食管入口及上段狭窄15例，中段狭窄32例，中上段狭窄17例，全长狭窄3例，均未完全闭锁。结果：显效43例，有效24例。因肿瘤复发全身转移器官衰竭或侵蚀周围大血管出血致死7例。随访时间4个月～5年1个月，平均9．8个月。结论：家用便携式扩张器及家庭自助扩张法是一种治疗食管狭窄安全而有效的方法，本法简单、方便、痛苦少及费用低，特别适合于基层医院和经济欠发达的农村地区。

Objective：To explore an economical protocol for esophageal stenosis treatment at home and evaluate the effects of portable esophageal dilater. Method：Sixty-seven patients with esophageal stenosis were treated at home by themselves with portable esophageal dilater, which was designed by Prof Wang HT, one of the authors. Twenty-nine cases of esophageal stenosis were caused by chemical damage, 23 cases by esophageal tumor, 13 postoperation cases with hypopharyngical and upper esophageal tumor and two cases by laryngeal thyroid gland recurrent tumor. Stricture happened at esophageal entrance and upper segment in 15 cases, at middle in 32 cases,both at middle and upper in 17 cases and at whole length of esophagus in three cases. Stricture was not complete atresia and dilaters could insert into esophagus in all patients. Result.. Significant effects were found in 43 patients and good effects in 24 patients. Seven deaths were caused by remote metastasis of recurrent cancer resulting in multiple organ failure or large blood vessels bleeding resulting of tumor erosion. Follow-up visit ranged from the shortest period of four months to the longest period of five years and 1 month, 9.8 months on average. Conclusion： Family portable dilater and self-catering dilation is an effective and safe method for treating esophageal stenosis. It is so simple, convenient, painless with low expense that it is especially useful in countryside hospitals and undeveloped rural areas.