内镜下球囊扩张联合博来霉素注射在难治性直肠术后吻合口良性狭窄中的应用

Endoscopic Dilation Combined With Injection of Bleomycin for Refractory Anastomotic Benign Stricture After Rectal Surgery

目的探讨内镜下球囊扩张联合博来霉素注射在难治性直肠术后吻合口良性狭窄中的疗效和安全性。方法回顾性分析2012年6月~2016年6月三家医院16例内镜下球囊扩张联合或不联合博来霉素注射治疗难治性直肠术后吻合口良性狭窄的临床资料。其中球囊扩张联合药物注射(博来霉素组)9例,单纯球囊扩张(球囊扩张组)7例。比较2组治疗效果和并发症。结果 16例吻合口狭窄均成功解除,术后临床症状消失。博来霉素组轻微并发症1例,球囊扩张组未发生并发症,2组差异无统计学意义(Fisher检验,P=1.000)。再次治疗时间间隔博来霉素组为(8.0±1.5)月,球囊扩张组为(5.1±1.0)月,差异有统计学意义(t=4.417,P=0.001)。结论与单纯内镜下球囊扩张相比,球囊扩张联合博来霉素注射可以延长再次治疗时间间隔,安全,有效。

Objective To investigate the efficacy and safety of endoscopic dilation combined with injection of bleomycin for refractory anastomotic benign stricture after rectal surgery. Methods Clinical data of 16 patients with refractory anastomotic benign stricture after rectal surgery who received endoscopic dilation or combined with injection of bleomycin were retrospectively analyzed,including 9 cases of dilation with bleomycin injection（ bleomycin group） and 7 cases of simple dilation（ dilation group）. The clinical efficacy and adverse events were compared between the two groups. Results All the patients received endoscopic treatment with a100% success rate. The strictures were managed successfully and the obstruction symptoms were relieved. Minor complication occurred in 1 case in the bleomycin group and no complication occurred in the dilation group. The two groups had no significant difference in the complication rate（ Fisher＇s Exact Test,P = 1. 000）. The mean re-intervention interval was（ 8. 0 ± 1. 5） months in the bleomycin group and（ 5. 1 ± 1. 0） months in the dilation group. The difference between the two groups was significant（ t = 4. 417,P = 0. 001）.Conclusion Compared with endoscopic dilation,endoscopic dilation combined with bleomycin injection can prolong re-intervention interval,which is a safe and effective endoscopic management.