球囊扩张术治疗食管胃吻合口狭窄21例体会

Balloon dilatation treatment of stoma stricture of esophagogastric anastomosis in 21 patients

目的采用球囊扩张方法治疗手术后食管胃吻合口狭窄。方法以１％利多卡因局部麻醉口咽部，以直头或“Ｊ”形导丝通过口咽、食管到达胃，交换球囊导管（球囊直径为１０～２２ｍｍ），将球囊放至狭窄中心，用水溶性造影剂充盈扩张。透视下使狭窄部完全扩开，持续１～４分钟。反复扩张２～３次。扩后抽净造影剂，拔出球囊和导丝。以临床症状和钡剂造影情况判定扩张效果，同时观察有无穿孔。结果本组２１例病人共扩张５３次，平均每人扩２５次，成功率为１００％。成功标准为摄入液体或固体均无吞咽困难。本组吻合口有轻度粘膜撕裂７例，无其它并发症发生。随访３～３５个月无复发。结论球囊扩张术治疗食管、胃吻合口术后狭窄，是一种安全、简单、有效的方法。

Objective Introducing a new balloon dilatation method for treatment of stoma stricture secondary to esophagogastric anastomosis. Method 1. Local anesthesia of oropharynx with 1% lidocaine.2.Straight or Jshaped guidewire was introduced,passing through the stricture into the stomach,then a balloon catheter,with diameter of 10 to 22 mm,was introduced to replace the guidewire.The balloon was properly positioned,and inflated with water soluble contrast material,under fluoroscopic control.The balloon inflation lasted for 1 to 4 minutes and repeated twice or thrice.3.Oral barium study was performed to verify the result of dilatation and absence of perforation. Result In a series of 21 patients,an average of 25 sessions of treatment per patient was needed.The technique was successful in each case as they all can take not only fluids but also solid food.Minor mucosal tears were detected in seven cases by barium examination,which was asymptomatic and needed no definite therapy.No recurrence of symptoms was found on 3 to 35 month followup examinations. WT5HZConclusion Balloon dilatation is a simple,safe and effective method for treatment of the stricture of esophagogastric anastomosis.