内镜下扩张联合注射博来霉素治疗食管手术后吻合口良性狭窄的安全性和有效性

Safety and efficacy of endoscopic dilation combined with bleomycin injection for anastomotic benign stricture after esophageal surgery

目的分析内镜下扩张联合注射博来霉素治疗食管手术后吻合口良性狭窄的安全性和有效性。方法回顾性分析2015年6月至2019年6月佛山市第一人民医院收治的食管手术后吻合口良性狭窄的55例患者。其中25例患者接受内镜下扩张联合注射博来霉素治疗(内镜下扩张联合博来霉素组),30例患者接受单纯内镜下扩张治疗(单纯内镜下扩张组)。比较两组患者缓解食管狭窄需要的时间、扩张相关的治疗费用、1年无狭窄生存时间、并发症发生情况。结果两组患者均顺利完成了内镜下治疗,治疗后短期内都达到了内镜和临床缓解。两组患者术后均未出现严重并发症,且两组患者术后并发症发生率差异无统计学意义[8.0%(2/25) vs 6.7%(2/30),χ~2=0.046,P=0.83]。在1年的随访时间内,内镜下扩张联合博来霉素组患者无狭窄生存时间长于单纯内镜下扩张组患者[(11.1±0.4)个月vs (3.9±0.2)个月],前者需要达到食管狭窄缓解的扩张次数更少[1 (1,2)次vs 3 (3,4)次],费用更低[5791.2 (4987.4,9974.8)元vs 16084.0 (14036.1,19094.0)元],且差异均有统计学意义(χ~2=54.322,Z=7.103、6.653,P均<0.01)。结论内镜下扩张联合注射博来霉素治疗食管手术后吻合口良性狭窄的疗效优于单纯内镜下扩张,可获得更长的无狭窄生存时间,并减少扩张次数。

Objective To evaluate the safety and efficacy of endoscopic dilation combined with bleomycin injection for anastomotic benign stricture after esophageal surgery.Methods A total of 55 patients with anastomotic benign stricture after esophageal surgery were retrospectively analyzed.Twenty-five patients received endoscopic dilation combined with bleomycin injection(endoscopic dilation combined with bleomycin group),and 30 patients received endoscopic dilation treatment alone(endoscopic dilation group).The time needed to alleviate esophageal stenosis,cost of dilation-related treatment,stenosis-free survival and complications were compared between the two groups.Results Both groups of patients successfully completed endoscopic therapy and achieved endoscopic and clinical remission in a short period of time after treatment.There were no serious postoperative complications in the two groups,and there was no statistically significant difference in the incidence of postoperative complications between the two groups[8.0%(2/25)vs.6.7%(2/30),χ2=0.046,P=0.83].During the 1-year follow-up,patients in the endoscopic dilation combined with bleomycin group had a longer survival time without stenosis than that in the endoscopic dilation group[(11.1±0.4)months vs.(3.9±0.2)months].Moreover,the median numbers of dilation required to resolve esophageal stenosis[1(1,2)vs.3(3,4)]and dilation-related cost[$5791.2(4987.4,9974.8)vs.$16084.0(14036.1,19094.0)]were both significantly lower in the endoscopic dilation combined with bleomycin group than those in the endoscopic dilation group.There were statistically significant differences(χ2=54.322,Z=7.103,6.653,all P<0.01).Conclusion Endoscopic dilation combined with bleomycin injection for benign anastomotic stenosis after esophageal surgery is more effective than endoscopic dilatation alone,which can prolong the stenosis-free survival time and reduce the number of dilation.