内镜下环周切开术治疗食管吻合口良性狭窄临床疗效观察

Clinical observation of endoscopic circumferential incision in the treatment of benign esophageal stricture

目的评价内镜下环周切开术(ECI)治疗食管胃吻合口狭窄的安全性和疗效。方法选取2012年7月至2016年1月海南省人民医院46例因食管癌、贲门癌术后食管胃吻合口良性狭窄行ECI治疗患者,观察手术安全性及其临床疗效。结果 46例患者均顺利行ECI治疗,吻合口直径从平均2~3 mm扩张至9~16 mm(平均达12 mm)。手术时间15~25 min,其中20例患者同时顺利将残留吻合钉取出。所有患者吞咽困难症状均有明显改善,吞咽困难评分经术后1、3、6个月随访,分别为由术前的平均分3.04分别降至1.07、1.17、1.35,较术前相比有显著性差异(P<0.01)。结论 ECI对治疗食管胃吻合口良性狭窄是一种安全有效的治疗方法。

Objective To evaluate the saftety and efficacy of endoscopic circumferential incision（ ECI） for esophageal anastomotic stricture. Methods Fourty-six cases due to esophageal cancer,cardiac surgery refractory benign esophageal anastomotic stenosis underwent endoscopic circumferential incision treatment to observe surgical safety and clinical efficacy. Results Fourty-six patients were successfully performoed endoscopic incision line treatment,with anastomotic diameter expanding from an average of 2-3 mm to 9-16 mm（ an average of 12 mm）.Operating time was 15-25 min,while residue staples of 20 patients were successfully removed. All symptoms were significantly improved in patients with dysphagia,dysphagia score after 1,3,6 months follow-up,respectively,by an average of 3. 04 points preoperatively were reduced to an average of 1. 07,1. 17 and 1. 35 points,respectively,compared with the preoperative phase there was significant difference（ P〈0. 01）. Conclusion The ECI for the treatment of benign esophageal anastomotic stenosis is a safe and effective method of treatment.