食管良性狭窄介入治疗方法和再狭窄原因

Interventional therapy and cause of restenosis of esophageal benign stricture

目的探讨食管良性狭窄有效的介入治疗方法，并分析发生术后食管再狭窄的原因．方法食管良性狭窄患者５０例，所有患者治疗前皆有不同程度的吞咽困难．男３２例，女１８例；年龄９岁～８５岁；原因贲门失弛缓３５例，消化性狭窄１例，吻合口狭窄１０例，化学烧伤性狭窄２例，食管癌放疗后疤痕狭窄２例；摄食能力分级１７例０级；１４例１级，１６例２级，３例３级．其中３５例采用Ｘ线下不同型号球囊导管扩张治疗１～５次．另１５例在Ｘ线下置入食管内支架．结果食管良性狭窄３５例共进行球囊扩张６７次，平均１９次．摄食能力术前后分级和术后症状复发时分级分别为１４３±０８０级，４８８±０８３级和１７１±０８２级．食管最狭窄处直径术前后和症状复发时分别为４０２ｍｍ±２０９ｍｍ，９８６ｍｍ±２９８ｍｍ和４５２ｍｍ±１９５ｍｍ．症状缓解时间为１ｍｏ～１２ｍｏ，平均３１４ｍｏ±２３７ｍｏ．食管良性狭窄支架置入术１５例，技术成功率１００％．支架置入前后摄食能力分级为０８±０８４级和３８±０４５级．食管管腔内径术前后为３６０ｍｍ±１３４ｍｍ，１８４ｍｍ±０８９ｍｍ．术后随访１０ｄ～３０ｍｏ，平均１０５ｍｏ．发生再狭?

IM :To study the effective interventional therapy on esophageal benign stricture, and analyze the causes of postoperative esophageal restenosis.METHODS Fifty patients with benign esophageal strictures, including achalasia in 35 patients, digest stricture in one, corrosive agent ingestion in 2, surgery in 10 and esophageal cancer after radiations in 2 patients. Food intake capacity was grade 0 in 17 patients, grade 1 in 14, grade 2 in 2 and grade 3 in 3 patients. Thirtyfive patients received 1 to 5 times dilations of different type balloon catheter in fluoroscopy, and 15 stent insertion of esophageal stricture.RESULTS Thirtyfive patients with esophageal benign stricture had 67 times dilations (mean 19 times). The mean food intake ability score was 143±080 before dilations and 488±083 after dilations and 171±082 during recurrence. The average diameter of esophageal most strictured area was 402mm±209mm before dilation and 986mm±298mm after dilation and 452mm±195mm during recurrence. The duration for symptomatic relief was 1 to 12 months (mean 314±237 months). Stent insertion was technically successful and dysphagia was effectively remitted in all 15 patients. The average food intake ability score was 080±084 before stent insertion and 380±045 after stent insertion. The mean diameter of esophageal lumen was 360mm±134mm before stent insertion and 1840mm±089mm after stent insertion. Followup time was from 10 days to 25 years (mean 105 months).CONCLUSION Interventional therapy of esophagus is the best method to improve shortterm curative effect in esophageal benign stricture. The hyperplasia of granulation tissue or formation of new scar tissue is the main cause of esophageal restenosis.