食管重建术后吻合口良性狭窄的选择性程式治疗

SELECTIVE THERAPEUTIC MODALITIES FOR BENIGN ANASTOMOTIC STRICTURES FOLLOWING ESOPHAGEAL RECONSTRUCTION

目的探索治疗食管重建术后不同程度吻合口良性狭窄的合理治疗方案。方法治疗食管重建术后吻合口狭窄１８４例。轻、中、重度狭窄分别是７１（３８．６％）、９２（５０．０％）、２１（１１．４％）例。采用选择性程式治疗方案，即确诊后均先试行食管扩张术，反复扩张无效者续用经口食管腔内置管术，扩张失败者改用手术治疗。结果全组施行单纯扩张术、置管术及手术治疗的分别占９３．２％、４．３％及２．５％。三种方法治疗的总有效率１００％，扩张术有效率９５．０％（１５０／１５８），置管术７例，手术４例治愈率分别是１００％（７／７）、１００％（４／４）。轻、中度狭窄扩张成功率１００％，有效率分别是１００％、９２．５％；重度狭窄扩张成功率８５．７％（１８／２１），有效率８７．５％。严重的并发症有食管穿孔２例。结论选择性程式治疗不同程度的食管重建术后吻合口良性狭窄，从简单到复杂，方案合理，使不同程度的吻合口狭窄患者均得到合理治疗，疗效显著。

Objective:To search for a reasonable therapeutic program for benign anastomotic strictures following esophageal reconstruction.Methods:The selective therapeutic modality consisted of simple dilation (first choice for all patients), endoprosthesis intubation and surgical treatment (for those who failed with dilation).184 cases were included.71(38.6%)、92(500%) and 21(11.4%) cases had grade 1,2 and 3 strictures respectively. Results:There were 93.1% cases performed with simple dilatation, 4.3% with intubation and 2.5% with surgery;and the effective rates were 95.0% (150/158),100% (7/7) and 100%(4/4) respectively.The successful rates of dilatation for grade 1 and 2 stricture were both 100%. and the effective rates were 100% and 92.5% respectively. These two rates for grade 3 group were 85.7% and 87.5%. In two patients perforation had occurred but were finally cured. Conclusion:This program was rational and effective for anastomotic stricture following esophageal reconstruction.