内镜下球囊扩张与放射状切开术治疗上消化道良性狭窄的短期效果评价

Short-term Efficacy of Endoscopic Radial Incision and Endoscopic Balloon Dilatation in the Treatment of Benign Upper Digestive Stricture

目的:评价内镜下放射状切开术(ERI)与内镜下球囊扩张术在治疗上消化道狭窄的短期效果。方法:回顾2018年5月-2020年1月,45例接受内镜下球囊扩张术和43例接受ERI的上消化道良性狭窄患者的临床资料,汇总吞咽困难改善情况、手术相关并发症及不适症状等。结果:45例患者顺利完成球囊扩张术,所有患者均未发生出血、穿孔等严重并发症,5例(11.1%)出现胸骨后疼痛(未使用止痛药物);43例均顺利完成ERI,所有患者均未发生出血、穿孔等严重并发症,术后11例(25.6%)出现胸骨后疼痛(未使用止痛药物),2例(4.7%)出现皮下气肿,予严密观察,气肿均自行吸收。45例球囊扩张术组患者术前吞咽困难评分(2.49±0.35)分,术后2个月降至(1.89±0.47)分(P<0.05),平均手术次数为(3.78±1.15)次;43例内镜下放射状切开术组患者术前吞咽困难评分为(2.63±0.94)分,术后2个月为(0.77±0.28)分(P<0.05),平均手术次数为(1.28±0.21)次。比较两组术后2个月吞咽困难评分及平均手术次数,差异均有统计学意义(P<0.05)。结论:两种治疗方法均具有良好的安全性,但内镜下放射状切开术具有更好的短期疗效,手术次数少,值得进一步推广,但其远期疗效仍待进一步研究。

Objective:To evaluate the short-term efficacy of endoscopic radial incision(ERI)and endoscopic balloon dilatation in the treatment of benign upper digestive stricture.Method:The clinical data of 45 patients underwent endoscopic balloon dilatation and 43 patients treated with ERI for benign stricture of upper digestive tract from May 2018 to January 2020 were retrospectively analyzed.The alleviation of dysphagia,surgical complication and discomfort were summarized.Result:Balloon dilatation was successfully completed in 45 patients.There were no serious complications such as bleeding and perforation occurred in all patients.Retrosternal pain occurred in 5 patients(11.1%)after operation(no painkillers were used).ERI was successfully performed in 43 patients.There were no serious complications such as bleeding and perforation occurred in all patients.Retrosternal pain occurred in 11 patients(25.6%)after operation(no painkillers were used for such patients),and subcutaneous emphysema was found in 2 patients(4.7%);such patients were closely observed,and the emphysema was self-absorbed.The score of dysphagia was(2.49±0.35)points in 45 patients before the balloon dilatation,and decreased to(1.89±0.47)points in 2 months after operation(P<0.05),and the average frequency of the operation was(3.78±1.15)times.The score of dysphagia was(2.63±0.94)points in 43 patients before the ERI,and decreased to(0.77±0.28)points in 2 months after operation(P<0.05),and the average frequency of operations was(1.28±0.21)times.The scores of dysphagia 2 months after operation and the average number of operations were compared between the two groups,and the differences were statistically significant(P<0.05).Conclusion:Both therapeutic methods are safe,and ERI has better short-term efficacy and less operation times,which is worthy of further promotion;however,the long-term efficacy of ERI needs to be further studied.