置入内置管治疗难治性食管良性狭窄

THE ENDOSCOPIC PLACEMENT OF ENDOPROSTHESIS IN THE MANAGEMENT OF REFRACTORY BENIGN ESOPHAGEAL STRICTURES

该文报告21例经扩张器、激光、微波等传统治疗仍反复发生重度吞咽困难的病人,经用微波扩张后置入内置管治疗取得了长久的缓解。15例为手术疤痕狭窄,4例放射治疗后引起,返流性食管炎和强碱灼伤引起各1例。方法为先将狭窄部用微波扩张至直径1.2cm,尔后经内镜置入内置管。14例1次成功,6例2次成功,1例失败。置管成功者均能进食半流质和软饭,吞咽困难程度由平均3.24度改善到1.5度。7例置管后2～6个月取除内置管仍能保持进食半流质。

Twenty-one patients with severe benign esophageal strictures requiring frequent dilation are the focus of this study. Endoprostheses made from collagen-silicone composites were endoscopically placed, and a long term effective palliation was made, Fifteen patients had post-surgical esophageal anastomotic strictures, four had strictures resulting from radiation therapy, one has a stricture from reflux esophagitis, and one had a stricture from lye ingestion. All strictures were dilated by endoscopic microwaves. When the dilated stricture reached 12cm in diameter, the endo-prosthesis was placed with an endoscope. Endoprostheses were successfully placed in 20 patients, six of whom required two insertions. The quality of swallowing improved for the 20 patients who received the endoprosthesis. The mean dysphagia grade improved from 3.24 to 1.5.