Can the Rectum Balloon Minimize Rectal Toxicity During Irradiation Therapy of Prostate Cancer?

The irradiation of the rectum cancer occurs in many institutes by using a rectum balloon in order to reduce the mobility of the target organ and to distance the rectum from the target organ. The objective is to reduce side effects quantitatively as well as qualitatively. On the basis of two hospitals using identical techniques for the prostate irradiation with the sole difference of the rectum balloon the toxicity has been evaluated with the result of no significant difference between the cohorts concerning diarrhea, rectal pain symptoms and rectal bleedings. Therefore the authors consider the use of the rectum balloon prior to each irradiation not necessary for the reduction of toxicity particularly due to the fact that the application is often very painful, especially for patients with hemorrhoids. The rectum balloon as a tool for the reduction of the prostate mobility was not objective of this study.

双球囊导管成形术治疗结直肠吻合口良性狭窄

目的评价透视下双球囊导管成形术治疗结直肠吻合口良性狭窄的疗效。方法17例结直肠吻合口良性狭窄的患者,在透视下行经肛门双球囊导管成形术。13例因恶性、4例因良性病变而接受结、直肠外科手术。16例因部分性梗阻表现为排便困难或排便次数增多,1例患者因溃疡性结肠炎,作全结肠切除术+临时性肠造瘘术后,其吻合口狭窄由内镜和钡灌肠检查发现并确定为良性。随访期观察疗效和并发症。结果17例患者在透视下进行了双球囊导管成形术1次。双球囊扩张成形术中,先用单球囊(直径为20mm)作为初步扩张,再附加第2枚球囊(直径为10、15或20mm)进行双球囊导管成形术。技术成功率为100%。球囊导管成形术后,症状完全改善12例(71%)、部分改善5例(29%)。未发生如肠破裂或严重出血等并发症。平均随访23个月(1～62个月),1例6个月后狭窄复发,给予再次双球囊导管成形术后,狭窄症状消失。结论透视下双球囊导管成形治疗良性结直肠吻合口狭窄安全可行。

内镜下球囊扩张术治疗结直肠吻合口良性狭窄的临床回顾性分析

目的评价内镜下球囊扩张术(EBD)治疗结直肠吻合口良性狭窄的安全性及疗效。方法2011年至2015年,复旦大学附属中山医院内镜中心行EBD治疗的36例结直肠吻合口良性狭窄病例纳入回顾性分析,统计扩张治疗次数、并发症发生情况、短期效果及长期狭窄复发情况。结果36例患者在外科手术后2~49个月(中位时间6个月)出现吻合口狭窄,吻合口距肛缘3~24cm(中位距离6cm)o10例(27.8%)为1级狭窄,15例(41.7%)为2级狭窄,11例(30.5%)为3级狭窄。36例共行80次EBD,平均每例2.22次,其中行1.2次25例(69.4%)、3次及以上11例(30.6%).EBD操作过程中,14例次(17.5%)出现吻合口少量渗血,无术中及术后穿孔发生。术后所有患者梗阻症状得到解除,吻合口直径大于20mm,EBD治疗取得成功。术后随访22~76个月(中位时间44个月),其中4例(11.1%)在EBD治疗成功后再次出现吻合口良性狭窄,出现时间分别为末次扩张术后的7、11、18、63个月,均经再次EBD治疗后好转。结论EBD在治疗结直肠吻合口良性狭窄方面安全有效,能取得较为理想的短期和长期结局。