内镜下放射状切开治疗食管吻合口良性狭窄的临床初探

Endoscopic radial incision in patients with benign stricture of esophageal anastomosis

目的评价内镜下放射状切开术（ERI）对于食管吻合口良性狭窄的治疗效果和安全性。方法回顾2013年10月至2014年9月间，17例接受ERI治疗的食管吻合口良性狭窄患者的临床资料，汇总临床症状的改善情况、手术相关并发症及不适症状等。结果17例均顺利完成ERI，平均操作时间10min，吻合口狭窄环平均切开4次。术中1例发生活动性出血及正常黏膜切开暴露肌层（内镜下止血成功后予胃肠减压及抗生素治疗），术后5例出现胸骨后疼痛（均可承受，未用止痛药物），未出现其他手术相关并发症及不适症状。17例术前吞咽困难评分平均3．11分，术后第2天降至0．90分（P〈0．01），出院随访9～20个月（平均15．5个月），随访至2015年6月患者吞咽困难评分与术后第2天比较无显著变化（P〉0．05）。结论对于食管吻合口良性狭窄，ERI治疗简单、安全、有效，值得进一步研究。

Objective To evaluate clinical efficacy and safety of endoscopic radial incision（ERI） for benign stricture of esophageal anastomosis. Methods Clinical data of 17 patients with benign stricture of e- sophageal anastomosis undergoing ERI from October 2013 to September 2014 were retrospectively studied. Im- provement of clinical symptom and treatment-related complication or discomfort were intensively analysed. Re- suits All 17 patients successfully received ERI procedures, and the mean operating time was 10 minutes with a mean of 4 incisions. Obvious bleeding and mis-eut of normal mucosa occurred in 1 case, and this patient was cured by endoscopic hemostasis, gastrointestinal decompression and administration of antibiotics. Heartburn oc- curred in 5 patients and disappeared spontaneously without other complications or discomfort.Dysphagia score decreased from 3. 11 to 0. 90 in the second day after ERI（P〈0. 01）.The mean follow-up time was 15.5 months （range 9-20 months）. The dysphagia score showed no significant difference between the follow-up period and the second day after ERI （P〉 0. 05 ）. Conclusion ERI is simple, safe and effective for treating benign stricture of esophageal anastomosis.