内镜双气囊扩张治疗食管吻合口狭窄的疗效

The clinical outcome of endoscopic double-balloon dilatation for cicatrical esophageal anastomotic strictures

目的观察内镜双气囊扩张治疗食管吻合口狭窄的疗效。方法对2009年1月―2012年12月于沈阳军区总医院内窥镜科经影像学检查或(和)内镜检查证实为吻合口狭窄的43例患者的临床资料进行回顾性分析。所有患者均行内镜下双气囊扩张治疗,以吻合口距门齿距离28cm为标准,将患者分入颈部吻合组(吻合口距门齿距离≤28cm,12例)和胸内吻合组(吻合口距门齿距离>28cm,31例)。比较两组患者的疗效和扩张治疗后患者满意率。结果颈部吻合组患者吻合口距门齿距离、食管手术至首次行扩张治疗的时间均显著短于胸内吻合组(P值均<0.05),行单次扩张治疗的比例显著低于胸内吻合组(P<0.05)。两组间性别构成、年龄的差异均无统计学意义(P值均>0.05)。颈部吻合组首次充分扩张成功率显著低于胸内吻合组(P<0.05),扩张治疗后1d、1和3个月的患者满意率分别显著低于胸内吻合组(P值均<0.05)。扩张治疗中,所有患者除有少量黏膜渗血、疼痛外,均未发生穿孔。扩张治疗后患者均有不同程度的胸部不适和疼痛,多可耐受,3~7d内均可逐渐消失。结论内镜双气囊扩张治疗食管吻合口狭窄是安全、有效的,首次充分扩张与吻合口位置、食管腔是否扩张和食管狭窄发生时间密切相关。

Objective To investigate the clinical outcome of endoscopic double-balloon dilatation for cicatrical esophageal anastomotic strictures. Methods A total of 43 patients with esophageal anastornotic strictures diagnosed by imaging or （and） endoscopy underwent endoscopic double-balloon dilatation between January 2009 and December 2012 in our hospital and were enrolled in this retrospective study. According to location of anastomotic strictures, the patients were divided into two groups （12 cases of cervical strictures and 31 cases of intrathoracic strictures）. Dilatation effect was compared between the two groups. Resutts The mean distance from stricture to incisor and onset of postoperative stricture development in the patients with cervical strictures were significantly shorter than those with intrathoracic strictures （both P〈0.05）. The patient for single dilatation was less than that for intrathoracic strictures （P〈0.05）. There were no significant differences in age or gender between two groups （both P〉0.05）. Achievement ratio of initial dilatation and patients＇s atisfaction 1 day, 1 month and 3 months after dilatation in those with cervical strictures were significantly lower than those with intrathoracic strictures （all P〈0.05）. Except for mucosa hemorrhage and pain, no perforation was found during dilatation. Pain and discomfort after dilatation were tolerated and relieved in 3 to 7days in all patients. Conclusion Endoscopic double-balloon dilatation is safe and effective in treating esophageal anastomotic strictures. Initial successful dilatation is closely related to location of anastomotic stoma, esophageal I^men dilatation and onset of stricture.