气囊扩张对74例良性溃疡伴幽门梗阻的长期疗效再探讨

Re-evaluation for long-term results of endoscopic balloon dilation on benign peptic pyloric stenosis

目的 再次评价气囊扩张对良性消化性溃疡伴幽门梗阻的长期疗效。方法 患者先行内科保守治疗 ,保守治疗不成功再行内镜下气囊扩张术。幽门螺杆菌阳性均给予根除治疗 ,抗溃疡病药物治疗至少一个月。结果 74例幽门梗阻中有 4 3例内科保守治疗成功 ,另 31例行气囊扩张术 (最大直径 1 2～ 1 4 mm) ,平均扩张次数为 1 .6 8±0 .83次。在随访 2 1 .0 6± 1 3.1 3个月中 ,梗阻的复发率分别为 4 .6 5 %和 1 6 .1 3% (P>0 .0 5 ) ,两组均未见并发症。结论 幽门梗阻气囊扩张术是一种安全、有效的方法 ,最终用多大直径的球囊扩张以梗阻症状解除为准 ,对良性溃疡伴幽门梗阻 ,即使是瘢痕型梗阻首选球囊扩张 ,如扩张不满意者才考虑手术治疗。

Objective To re evaluate long term results of endoscopic balloon dilation on benign peptic pyloric stenosis.Methods All the patients underwent the medical therapy first.Through the scope balloon dilations were given to those unsuccessful.H.pylori was eradicated if H.pylori test positive and anti ulcer medicine was given at least one month.Results Of the 74 patients,43 cases were successfully treated with the medical therapy and 31 needed balloon dilations(largest diameter was from 12 mm to 14 mm).The average times for dilation were 1 68±0 83 times.At the follow up for 21 06±13 13 months,the recurrent rates of obstruction were 4 65% and 16 13%( P >0 05)respectively.No complications were present in both groups.Conclusion The endoscopic balloon dilation is safe and effective.What size of the balloon should be used at last depends on whether the obstruction symptoms are gone.Balloon dilation first to be used for benign peptic pyloric stenosis is recommended,even for cicatricial pyloric obstruction.Surgical treatment is required only for those with balloon dilation unsatisfied.