双球囊导管成形术治疗结直肠吻合口良性狭窄

Benign colorectal anastomotic strictures: treatment under fluoroscopic guidance by double balloon dilation

目的评价透视下双球囊导管成形术治疗结直肠吻合口良性狭窄的疗效。方法17例结直肠吻合口良性狭窄的患者,在透视下行经肛门双球囊导管成形术。13例因恶性、4例因良性病变而接受结、直肠外科手术。16例因部分性梗阻表现为排便困难或排便次数增多,1例患者因溃疡性结肠炎,作全结肠切除术+临时性肠造瘘术后,其吻合口狭窄由内镜和钡灌肠检查发现并确定为良性。随访期观察疗效和并发症。结果17例患者在透视下进行了双球囊导管成形术1次。双球囊扩张成形术中,先用单球囊(直径为20mm)作为初步扩张,再附加第2枚球囊(直径为10、15或20mm)进行双球囊导管成形术。技术成功率为100%。球囊导管成形术后,症状完全改善12例(71%)、部分改善5例(29%)。未发生如肠破裂或严重出血等并发症。平均随访23个月(1～62个月),1例6个月后狭窄复发,给予再次双球囊导管成形术后,狭窄症状消失。结论透视下双球囊导管成形治疗良性结直肠吻合口狭窄安全可行。

Objective To evaluate the therapeutic efficacy and complications of fluoroscopically guided double balloon dilation in the treatment of benign colorectal anastomotic strictures. Methods Under fluoroscopic guidance, 17 patients with benign colorectal anastomotic strictures underwent transanal double balloon dilation, including 13 patients underwent resection for malignant disease, and 4 for benign conditions. 16 out of 17 patients had difficulty or frequent defecation due to partial obstruction. The remaining one patient had the stricture detected by endoscopy and barium enema after total proctocolectomy and a temporary ileostomy for ulcerative colitis. Therapeutic efficacy and complications were evaluated in the follow-up visits. Results Seventeen patients received double balloon dilation in a single session. The diameter of double balloon catheter was arranged from 30 to 40 mm. Technical success achieved in all 17 patients with complete release （n = 12, 71%） or incomplete one （n = 5, 29%） and 100% improvement of symptoms was achieved in all patients, together with no major complications such as perforation or severe hemorrhage. During the mean follow-up of 23 months （range, 1 - 62 months）, one patient （6%） developed a recurrent stricture and needed a second balloon dilation six months after the initial balloon dilation. Conclusions Fluoroscopically guided double balloon dilation is an effective and safe method for treating benign colorectal anastomotic strictures. （J Intervent Radiol, 2006, 15： 543-546）