内镜下放射状切开术与球囊扩张术治疗食管良性狭窄的临床研究

Endoscopic radial incision and balloon dilation in treatment of benign esophageal stricture

目的比较内镜下放射状切开术(ERI)与球囊扩张术(EBD)治疗食管良性狭窄的手术时间、有效性和安全性。方法选取2014年1月至2018年7月在本院住院治疗的38例食管良性狭窄患者作为研究对象,其中17例行放射状切开术治疗(ERI组),21例行球囊扩张术治疗(EBD组);比较两组性别、年龄及狭窄病因等临床资料;统计每组患者的吞咽困难评分和手术操作时间,观察术后1周、1个月、3个月、6个月和12个月的疗效及并发症情况。结果ERI组中位手术时间15 min(11~31 min),手术时间(17.6±5.8)min;EBD组中位手术时间11 min(7~16 min),手术时间(11.2±2.6)min,两组比较差异有统计学意义(P<0.05);术后1周、1个月,两组患者治疗有效率均为100.0%;术后3个月、6个月,ERI组有效率分别为82.4%(14/17)、62.5%(10/16),EBD组分别为71.4%(15/21)、33.3%(7/21),两组比较差异均无统计学意义(均P>0.05);术后12个月,两组患者有效率分别为46.7%(7/15)、10.0%(2/20),差异有统计学意义(P<0.05);两组患者均未出现严重胸痛、感染、出血和穿孔等并发症。结论内镜下放射状切开术治疗食管良性狭窄与球囊扩张术相比虽然手术耗时较长,但术后6个月内疗效相当、12个月时疗效更佳,而且具有同样的安全性,值得临床推广应用。

Objective To compare the operation times,efficacies,and safety of endoscopic radial incision(ERI)and balloon dilatation(EBD)in treatment of benign esophageal stricture.Methods A total of 38 patients with benign esophageal stricture,who were hospitalized in our hospital from January,2014 to July,2018,were selected as study objects.Of which,17 were treated with ERI(ERI group),and 21 with EBD(EBD group).The clinical data,such as sex,age,and etiology of stenosis,were compared between the two groups.The dysphagia scores and operation times of were recorded.The curative effects 1 week,1 month,3 months,6 months,and 12 months after operation and the complications were observed.Results The median operation time and the mean operative time were 15 min(11-31 min)and(17.6±5.8)min in the ERI group,and were 11 min(7-16 min)and(11.2±2.6)min in the EBD group,with a statistical difference(P<0.05).One week and one month after the operation,the treatment effective rates both were 100.0%(17/17)in the ERI group and 100.0%(21/21)in the EBD group,respectively.The effective rates 3 and 6 months after the operation were 82.4%(14/17)and 62.5%(10/16)in the ERI group,and were 71.4%(15/21)and 33.3%(7/21)in the EBD group,with no statistical differences between the two groups(both P>0.05).The effective rate 12 months after the operation was 46.7%(7/15)in the ERI group,and was 10.0%(2/20)in the EBD group,with a statistical difference(P<0.05).No serious chest pain,infection,bleeding,and perforation occurred in both groups.Conclusions Compared with balloon dilatation,although endoscopic radial incision takes a longer time in the treatment of benign esophageal stenosis and its effect within 6 months is equal with balloon dilatation,the effect 12 months after operation is better and it has the same safety,so it is worthy of clinical application.