食管良性狭窄介入治疗方法探讨和再狭窄原因分析

Method Study and Cause Analysis of Restenosis of Esophageal Benign Stricture with Intervention Therapy

目的:探讨食管良性狭窄有效的介入治疗方法,并分析发生食管再狭窄的主要原因。对象与方法:50例食管良性狭窄病人,其中35例采用X线下不同型号球囊导管扩张治疗。另15例在X线下置入食管内支架。所有病人治疗前皆有不同程度的吞咽困难。结果:35例食管良性狭窄共进行67次球囊扩张,平均1.9次。摄食能力术前后分级和术后症状复发时分别为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4.02±2.09mm.9.86±2.98mm和4.52±1.95mm。症状缓解1～12月,平均3.14±2.37个月。15例食管良性狭窄支架置入术技术成功率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3.6±1.34mm.18.4±0.89mm。术后随访10天～30月,平均10.5个月。发生再狭窄3例。结论:食管狭窄介入治疗是提高食管良性狭窄治疗短期疗效的首选方法。食管再狭窄主要是肉芽组织增生所致。

Purpose: To study the effective methods of esophageal benign stricture with inter- vention therapy, and analyzed the cause of esophageal restenosis. Materials and Methods: 50 patients with esophageal benign stricture aged from 14 to 85 years old. There were 35 patients with 1 to 5 times of dilation by different types of balloon catheter under fluoroscopy; and 15 patients with stent insertion at the esophageal stricture. All patients had different grades of dysphagia beforehard. Results: 35 patients with esophageal benign stricture had 67 times of dilations (mean 1.9times). The mean food intake ability score was 1.43±1.0.80 before dilations and 4.88±0.83 after dilations and 1.71±0. 82 during stricture recurrence. The mean diameter of the most stentic esophage was 4.02±2.09mm before dilation and 9.86±2.98mm after dilation and 4.52±1.95mm during stricture recurrence. Time for symptomatic relief was 1 to 12 months(mean 3.14±2.37months). Stent insertion was technically successful and dysphagia was effectively remitted in all 15 patients. The mean food intake ability score was 0.8±0.84 before stent insertion and 3.8±0.45 after stent insertion. The mean diameter of esophageal lumen was 3.6±1.34mm before stent insertion and 18.4±0.89mm after stent insertion. Follow-up time was from 10 days to 2.5 years(mean 10.5 months). Conclusion: This method should be the first chlice of short- term curative effect in the therapy of esophageal benign stricture. Hyperplasia of granulation tissue cor relation with formation of esophageal restenosis were discussed.