内镜下放射状切开术治疗难治性上消化道良性狭窄的临床研究

Clinical study of endoscopic radial incision for refractory benign upper digestive tract stricture

目的探讨内镜下放射状切开术(ERI)治疗难治性上消化道良性狭窄的有效性和安全性。方法回顾性分析2017年11月-2020年1月苏北人民医院因上消化道良性狭窄行ERI治疗的患者14例,记录患者术前狭窄时间、术前接受治疗情况、术前术后吞咽困难症状、吻合口直径改善情况、术中术后并发症发生情况,并评估其疗效。结果14例患者均完成ERI术,平均操作时间(13.21±4.26)min,切开部位(2.17±0.58)处,所有患者均未出现穿孔和出血等并发症,术前吞咽困难评分为(3.08±0.52)分,术后第2天降至(1.14±0.35)分,术前术后比较,差异有统计学意义(P<0.05),术后3和6个月吞咽困难评分分别为(1.23±0.58)和(1.39±0.66)分,与术后第2天比较,差异无统计学意义(P>0.05),术前、术后当时和术后3个月狭窄处直径分别为(0.28±0.04)、(1.23±0.02)和(1.11±0.03)cm,3个时点比较,差异有统计学意义(P<0.05),术后当时与术后3个月比较,差异无统计学意义(P>0.05)。结论ERI治疗难治性上消化道良性狭窄是安全有效且可行的。

Objective To explore the efficacy and safety of endoscopic radial incision(ERI)for refractory benign upper digestive tract stricture.Methods The medical records of 14 patients with benign upper digestive tract stricture who underwent radial incision from November 2017 to January 2020 were retrospectively reviewed.The clinical information of the patients was recorded,including duration of stricture preoperatively and treatments received preoperatively,symptoms of dysphagia preoperatively and postoperatively,improvement of anastomotic diameter,and intraoperative and postoperative complications,and the efficacy was evaluated.Results All the 14 patients completed the ERI,the average operation time was(13.21±4.26)min,and the incision site was(2.17±0.58).All the patients did not develop complications such as perforation and bleeding.The average dysphagia score was(3.08±0.52)before operation and decreased to(1.14±0.35)the second day after operation.The preoperative and postoperative differences were statistically significant (P < 0.05). The scores of dysphagia at 3 and 6 months after surgery were (1.23 ± 0.58) points and (1.39 ± 0.66) points, compared with the second day after operation, the difference was not statistically significant (P > 0.05). The diameters of the stenosis before operation, immediately after operation, and 3 months after operation were (0.28 ± 0.04) cm, (1.23 ± 0.02) cm and (1.11 ± 0.03) cm, respectively. The preoperative and postoperative differences were statistically significant (P < 0.05). There was no significant difference between the time after operation and 3 months after operation (P > 0.05). Conclusion Endoscopic radial incision is safe, effective and feasible for refractory benign upper digestive tract stricture.