介入性球囊技术在上胃肠道吻合口狭窄中的应用

Application of balloon ductal dilatation in anastomotic orifice stenosis of upper gastrointestinal tract

目的探讨在X线监视下介入性球囊扩张技术在治疗上胃肠道术后吻合口狭窄中的临床应用价值。方法 17例确诊为上胃肠道术后吻合口狭窄的患者,在X线监视下经口腔分别引入泥鳅导丝、Cobra导管、超硬导丝,将球囊导管送入,球囊中部置于吻合口(或狭窄)处,逐渐充盈球囊至"腰征"消失,持续10min,反复2～3次,抽瘪、回撤球囊,造影判断扩张效果,术后定期随访,观察患者临床症状缓解情况。结果 17例患者共进行27次球囊扩张,平均约1.5次,成功率100%;术后患者即时吞咽困难症状缓解率为100%。近期(1个月)有效率达94.12%,远期(12个月)有效率达82.35%,所有病例均未出现食管破裂穿孔、大出血和感染等并发症。结论 X线监视下介入性球囊导管扩张术治疗上胃肠道术后吻合口狭窄,操作简单、安全、效果理想,可反复操作,具有较高的临床应用价值,可作为上胃肠道术后吻合口狭窄临床治疗的首选方法之一。

Objective To discuss the clinical value of interventional balloon ductal dilatation technique in the treatment of the upper gastrointestinal tract anastomotic orifice stenosis in X - ray monitoring. Methods By inducting respectively the hydrophilie guide wires, Co- bra eatheter and super - hard guide wire through the mouth in X - ray, the balloon catheter was send into the upper gastrointestinal tract of 17 patients who were diagnosed as the anastomotic orifice stenosis. The middle part of the balloon must be placed in the anastomotic stoma （ or stenosis）. Filled the balloon gradually till the ＂Waist sign＂ disappeared, and kept it for 10min. Repeated this procedure 2 or 3 limes. Then deflated and retraced the balloon. Determined expansion effeet through radiography. Followed up patients regularly after operation to observe the clinical symptom remission. Results 17 patients get a total of 27 balloon valvuloplasty treatments, each about 1.5 times the average. Success rate is 100%. The rate of alleviation of immediate postoperative dysphagia symptoms is 100%. By Х^2 testing,P 〈 0. 01 ,the difference has a statistic significant. Effective rate of short term（ 1 months） is 94.12%, of long - term （ 12 months） is 82.35%. All patients are found no serious complieations such as esophagus breakage perforation, massive hemorrhage or infection. Conclusion The interventional balloon duetal dilatation technique used in the treatment of upper gastrointestinal anastomotie stenosis in X - ray monitoring, is simple, safe, and has satisfactory results, which can be repeated handling. With high clinical value, it can be taken as the preferred method of elinical treatment of upper gastrointestinal surgery anastomotic stenosis.