内镜下扩张治疗食管癌术后吻合口良性狭窄的疗效分析

Endoscopic expansion therapy of anastomotic stenosis after esophagectomy

目的探讨内镜下扩张治疗用于食管癌术后吻合口狭窄的临床疗效。方法将213例食管癌术后吻合口狭窄患者随机分为4组,分别行探条扩张、球囊扩张、探条扩张+暂时性支架置入及球囊扩张+暂时性支架置入治疗,术后观察患者临床症状缓解情况。结果 4组总有效率分别为81.6%、80.4%、95.0%、96.2%,探条组与球囊组总有效率差异无统计学意义(P>0.05);置入暂时性支架组总有效率高于单纯探条或球囊组,差异有统计学意义(P<0.05);置入暂时性支架组平均扩张(1.48±0.86)次,单纯探条或球囊组平均扩张(2.26±1.37)次,前者扩张次数明显低于后者,差异有统计学意义(P<0.01);支架组与无支架组术后并发症发生率的差异无统计学意义(P>0.05)。结论内镜下置入暂时性食管支架相对于单纯性探条或球囊扩张治疗食管癌术后良性狭窄,疗效显著,平均扩张次数少,并发症少,能明显改善患者的临床症状。

Objective To evaluate the clinical efficacy of endoscopic expansion therapy on esophageal anastomotic stenosis.Methods A total of 213 patients with esophageal anastomotic stenosis were divided into four groups randomly.They were treated by bougienage,balloon dilatation,bougienage combined with temporary stenting and balloon dilatation combined with temporary stenting respectively.Results The total effective rate of each group was 81.6%,80.4%,95.0%,96.2%,respectively.There was no difference of the total effective rate between bougie and balloon group（P〉0.05）.But the total effective rate of the stenting group was higher than simple bougie or balloon group（P〈0.05）.In addition,the dilation times of the stenting group was significantly lower than simple bougie or balloon group（P〈0.01）.Furthermore,there was no difference of the incidence of complications between the stenting group and simple bougie or balloon group（P〉0.05）.Conclusion Endoscopic temporary stenting has better efficacy and lower dilation times than simple bougie or balloon group.This therapy can improve the patients＇ clinical symptoms obviously.