内镜下放射状切开治疗食管ESD术后狭窄的临床研究

Clinical study on treatment with endoscopic radial on esophageal stricture after endoscopic submucosal dissection incision

[目的]探讨内镜下放射状切开(endoscopic radial incision ERI)治疗食管内镜黏膜下剥离术后狭窄的有效性和安全性。[方法]收集食管内镜黏膜下剥离术后狭窄患者11例,记录患者临床信息、术前狭窄时间、术前接受治疗情况,统计术前及术后吞咽困难评分、吞咽困难改善情况,记录术中、术后并发症,评估其疗效。[结果]11例患者均完成ERI术,平均操作时间(25.45±16.00)min,平均狭窄长度(2.72±1.48)cm,所有患者均未出现穿孔、出血等并发症。胃镜评估狭窄处直径术前为(0.34±0.14)cm,术后第3天、第3个月、第6个月、第12个月分别为(1.26±0.19)、(1.16±0.22)、(1.14±0.20)、(1.15±0.21)cm,术后与术前比较差异明显(P<0.05)。吞咽困难评分术前为(3.09±0.54)分,术后第3天、第3个月、第6个月、第12个月分别为(1.18±0.60)、(1.45±0.69)、(1.80±0.98)、(1.76±0.87)分,术后与术前比较差异明显(P<0.05)。[结论]ERI治疗食管内镜黏膜下剥离术术后狭窄是安全、有效的。

[Objective]To explore the efficacy and safety of endoscopic radial incision(ERI)on the treatment of Esophageal stricture after endoscopic submucosal dissection(ESD).[Methods]Eleven patients with stenosis after esophageal endoscopic submucosal dissection were collected,and clinical information,preoperative stenosis time and preoperative treatment were recorded.Preoperative and postoperative dysphagia scores and improvement of dysphagia were evaluated,intraoperative and postoperative complications were recorded,and the efficacy was evaluated.[Results]All 11patients completed ERI.The average operation time of ERI was(25.45±16.00)min,the average length of stenosis was(2.72±1.48)cm.No perforation and bleeding occurred in all patients.The diameter of the stenosis evaluated by gastroscope before operation and 3days,3months,6months and12months after operation were(0.34±0.14),(1.26±0.19),(1.16±0.22),(1.14±0.20),(1.15±0.21)cm.There was significant difference before and after operation(P<0.05).The preoperative dysphagia score was 3.09±0.54.At the 3rd day after operation,the score decreased to 1.18±0.60.There was significant difference between the two groups(P<0.05),the dysphagia scores were 1.18±0.60,1.45±0.69,1.80±0.98and 1.76±0.87at 3,6and 12months postoperatively.[Conclusion]It is safe,effective and feasible to treat esophageal stenosis after ESD by endoscopic radial incision.