扩张术治疗食管、贲门癌术后吻合口狭窄

DILATATION OF ANASTOMOTIC STRICTURE AFTER RESECTION OF ESOPHAGEAL AND CARDIAC CARCINOMA

回顾总结扩张术治疗食管、贲门癌术后吻合口狭窄的临床经验。方法 :采用金属食管镜下橄榄形扩张器及电子纤维胃镜下沙氏扩张器对 1 !0 39例行扩张术。前者 6 85例 ,平均 1.7次 /人 ,其中 7例沙氏扩张器失败而改用橄榄形扩张器 ,47例在取食管异物后行扩张术 ,后者 35 4例 ,平均 2 .0次 /人。所有病人扩张后均能进食普食。结果 :采用橄榄形扩张器未能完成扩张 32例 ,包括插管失败 4例 ,扩张失败 7例及因吻合口复发而终止 2 1例。术后发生吻合口穿孔 4例 (0 .5 8% ) ,死亡 2例 ;出血 6例。沙氏扩张器未能扩张 2 0例 ,引导丝不能通过吻合口 9例 ,吻合口复发而放弃 11例。吻合口穿孔 2例 (0 .5 6 % ) ,出血 4例。结论 :二种扩张法是有效的、安全的、并能被病人接受。沙氏扩张器操作简便 ,病人痛苦少。橄榄形扩张器特别适用取食管异物及严重狭窄病人。选取何种扩张法主要取决于病情和术者的经验。

Objective: To review the experience in dilatation of anastomotic stricture after resection of esophageal and cardiac carcinoma. Methods: 1811 dilations using both olive-shaped bougie dilators under rigid endoscopy and Celestin dilators under fiberendoscope were carried out on 1039 patients over a period of 20 years. Olive-shaped bougie dilators were done on patients with an average of 1.7 dilations per patient. Celestin dilations were done on 354 patients with an average of 2.0 dilations per patient. The procedure was considered effective when patients were able to maintain a solid diet after the last dilation. Results: 32 patients failed in olive-shaped bougie dilators because rigid endoscopy could not be tolerated in 4, unfinished in 7, and anastomotic recurrences were found in 21. Twenty patients failed in Celestin dilators because of the failure to pass the stricture in 9 and anastomotic recurrence in 11. Complications were observed. Perforation and anastomotic bleeding occurred in 4 and 6 patients undergoing olive-shaped bougie dilations, and in 2 and 4 patients undergoing Celestin dilations, respectively. 2 patients died of perforation in olive-shaped bougie dilation. Conclusions: Both methods of dilations are equally effective, safe as well as acceptable to patients. Celestin dilation is easier to perform and well tolerated. Foreign bodies and serious stricture in the anastomotic require olive-shaped bougie under rigid endoscopy for safe removal and dilation. The choice of the method of dilatation depends on the patient's needs and operator's experience.