内镜治疗结直肠狭窄的探讨

目的：探讨经内镜球囊扩张和金属支架置入术治疗结直肠良、恶性狭窄的临床疗效。方法：经内镜球囊扩张共治疗结直肠狭窄16例,其中良性狭窄11例,癌性狭窄5例。有3例癌性狭窄经扩张后放置金属支架。结果：11例良性狭窄病变经过2－4次球囊扩张治疗后,均解除梗阻症状,无1例需手术治疗。5例癌性狭窄,有3次经扩张后放置金属支架成功,2例解除梗阻后接受手术治疗,1例直肠癌术后复发肠腔狭窄伴盆腔广泛转移者扩张治疗失败。结论：经内镜球囊扩张和金属支架置入术治疗结直肠狭窄是一种简单、安全、有效的方法。     

内镜下切开术联合探条扩张治疗食管良性难治性狭窄的研究

目的探讨内镜下切开术联合探条扩张治疗食管良性难治性狭窄的疗效。方法选取反复探条扩张疗效不佳的17例吻合口狭窄患者,进行内镜下切开术联合探条扩张治疗,观察症状改善情况,吻合口直径变化,再狭窄间隔时间。结果所有患者均成功进行了内镜下切开联合探条扩张治疗,较单纯扩张治疗相比,患者吞咽困难症状明显改善,吻合口扩大(P0.05),平均缓解时间延长(P0.05)。结论内镜下切开术联合探条扩张治疗食管良性难治性狭窄是安全、有效的。     

内镜下放射状切开治疗上消化道良性狭窄的临床初探

目的评价内镜下放射状切开(ERI)治疗上消化道良性狭窄的安全性及有效性。方法将食管、胃良性狭窄患者(包括吻合口狭窄、内镜下黏膜剥离术后狭窄及腐蚀性狭窄)纳入该试验中,记录其狭窄程度、病变长度和瘢痕厚度等,内镜下对狭窄病变进行ERI,必要时辅助球囊扩张,并记录术后症状改善情况、并发症及患者预后。结果一共7例入组该试验,均成功行ERI治疗,其中4例联合球囊扩张,术后所有患者吞咽困难均明显改善,有1例术后少量出血,经保守治疗后缓解。在长期随访过程中,大多数患者经过1或2次ERI后可达到长期缓解。结论 ERI治疗上消化道良性狭窄是安全有效的,可以延长管腔通畅时间,值得临床推广。     

经内镜金属支架植入治疗结直肠癌合并梗阻病人的护理

[目的]总结经内镜金属支架植入治疗结直肠癌合并梗阻病人的护理。[方法]对9例结直肠癌合并梗阻病人行经内镜金属支架植入治疗,同时加强护理。[结果]9例病人均成功放置支架,支架放置成功后可见较多肠内容物流出,5例病人放置2d~3d 后梗阻症状得到缓解,解除梗阻和肠道准备后6d~9d接受结直肠肿瘤切除术;术后恢复良好,无手术切口感染、吻合口漏等并发症发生。[结论]加强经内镜金属支架植入治疗结直肠癌合并梗阻病人的护理是手术成功的保证。     

食管吻合口良性狭窄内镜介入治疗的临床观察

目的 :评价不同内镜介入治疗方法对食管吻合口良性狭窄的治疗效果。方法 :2 4例食管吻合口良性狭窄患者 ,根据其治疗方法不同分为 :永久性金属支架扩张术组 4例 (A组 ) ,暂时性金属支架扩张术组 12例 (B组 ) ,经Savary -Gilliard扩张器扩张治疗8例 (C组 )。所有患者治疗前吻合口最窄处直径 0 .1～ 0 .8cm ,吞咽困难STOOLER分级 2～ 4级 ;治疗后吻合口最窄处 1.3～ 2 .0cm ,吞咽困难STOOLER分级 0～ 1级。所有患者术后随访 1～ 18个月不等。结果 :A组术后 1年的随访患者中 10 0 % ( 4 /4 )复发吞咽困难。B组术后 1年的随访未发现吞咽困难复发。C组术后 2个月的随访患者 10 0 % ( 8/8)复发吞咽困难。结论 :暂时性金属支架扩张术是食管吻合口良性狭窄介入治疗的首选方法 ,时间一般以不超过一周为宜。     

内镜下沙氏探条扩张治疗食管癌术后 吻合口良性狭窄207例临床分析

目的 探讨内镜引导下多聚乙烯沙氏（Savary-Gilliard）探条扩张术治疗食管癌术后吻合口良性狭窄致吞咽困难的疗效。方法 2008年1月-2012年5月,在该院内镜中心因食管癌术后吻合口良性狭窄行沙氏探条扩张术的患者207例,共行493次扩张治疗。其中,男性145例,女性62例;平均年龄58.3岁。根据症状缓解评分评估其临床疗效。结果 所有患者经治疗后吞咽困难均获得缓解,即刻治疗有效率为100％。随访3、6和12个月,治疗有效率分别为93.2%、85.5%及72.5%。无效复发的患者再次行探条扩张术后症状能有所缓解,平均扩张3.5次。该组均未出现食管穿孔或严重出血等严重并发症。结论 内镜下探条扩张具有简便、安全有效、创伤小及可反复实施等优点,可作为食管癌术后吻合口良性狭窄的重要治疗手段,具有良好的近期和远期效果,提高患者生活质量。     

内镜下球囊扩张治疗良性胃输出端梗阻的临床价值

【目的】探讨经内镜球囊扩张治疗溃疡病胃输出端良性梗阻的疗效和安全性。【方法】对23例良性胃输出端梗阻患者采用气囊扩张治疗,术后对溃疡病HP阳性者进行HP根治,用内镜、钡剂造影定期随访并观察梗阻症状。【结果】患者的近期症状缓解率为91.3%,治疗后狭窄口平均直径由(5.1±2.6)mm增加到(15.2±1.2)mm(P<0.01),所有患者HP均被根除。主要并发症为黑便(8.7%)与呕血(4.3%)。术后随访0.5、1、2年的梗阻症状缓解率依次为82.6%、81.3%、76.9%,而梗阻症状复发率依次为17.4%、18.7%、23.1%。【结论】经内镜球囊扩张是治疗良性胃输出端梗阻的安全而有效的方法。     

肠道恶性梗阻内镜水囊扩张和支架治疗

目的：探讨经内镜水囊扩张和金属支架置入术治疗肠道恶性梗阻的临床运用价值。方法：经内镜水囊扩张和金属支架置入术共治疗18例肠道恶性梗阻的病人，其中十二指肠恶性狭窄7例，直肠恶性狭窄8例，乙状结肠恶性狭窄3例。结果：7例十二指肠恶性梗阻经内镜水囊扩张后放置支架成功；11例结直肠恶性梗阻中，8例扩张后放置金属支架作姑息治疗．2例经内镜水囊扩张和支架治疗解除梗阻后接受手术治疗，1例直肠癌术后狭窄伴盆腔广泛转移者扩张治疗失败。结论：经内镜水囊扩张和金属支架置入术治疗肠道恶性狭窄梗阻是一种操作简单、经济有效、并发症少的方法，可以显著降低病人的创伤和痛苦，提高病人的生活质量。     

9例经尿道射精管口切开术治疗射精管梗阻报告

目的 探讨经尿道射精管口切开术治疗射精管梗阻的可行性和疗效.方法 对2002年3月至2006年11月收治的9例射精管梗阻患者行经尿道射精管口切开术治疗,术后随访其疗效.结果 9例均完成手术,术后随访2～12个月,9例术后精液质量改善,4例不育患者妻子1年内全部妊娠.结论 经尿道射精管口切开术是治疗射精管梗阻的有效方法.     

内镜下扩张治疗食管吻合口狭窄36例临床疗效分析

目的探讨内镜下探条扩张治疗食管癌术后吻合口狭窄的临床疗效。方法对36例食管癌术后吻合口狭窄致吞咽困难的患者行内镜下Savary-Gilliard探条扩张器扩张术,并常规活检以排除局部癌症复发。根据临床症状缓解情况进行Stoole分级,评估其疗效。结果 36例患者治疗后吞咽困难症状较治疗前均有改善,34例完全缓解,1例基本缓解,1例无明显改善,经多次扩张后症状有所缓解。无1例发生出血、穿孔、感染等并发症。结论内镜下探条扩张治疗食管癌术后吻合口狭窄操作简单、创伤小、安全、有效。     

Dilation of benign strictures following low anterior resection using Savary-Gilliard bougies

BACKGROUND AND STUDY AIMS: Benign anastomotic strictures occur in up to 22% of patients after colorectal resections. Initially, treatment for these strictures was surgical, but nowadays endoscopic dilation techniques are preferred. This study was conducted to assess the efficacy of dilation using SavaryGilliard bougies. PATIENTS AND METHODS: From 1987 to 1994, 256 consecutive patients underwent low anterior resection (LAR). Twenty-one patients (8.2%) developed a stricture of the colorectal anastomosis. Follow-up data were available for 18 of these patients. The patients were treated using endoscopic Savary dilation, with bougies of increasing diameters (10-19 mm). The mean follow-up period was 19 months (1-60 months). RESULTS: Stricture symptoms presented after a mean period of 7.7 months after LAR. In three of the 18 patients, the stenosis was caused by local recurrence, and these patients were excluded from further evaluation. Normal defecation was restored in 10 of the remaining 15 patients, and symptoms disappeared. In five patients, there was only partial improvement, but only three of them required another type of treatment. Of four patients who received radiotherapy and developed a strictured anastomosis, two had successful dilations. A normal defecation pattern was never regained if more than three dilations were necessary. No complications caused by Savary dilation were observed. CONCLUSIONS: In this study population, Savary dilation appeared to be a safe and effective treatment for benign anastomotic strictures after LAR. All successfully treated patients (ten of 15) required no more than three dilations. Two other patients had partial success. Only three patients required another form of treatment (two endoscopic, one surgical).     

Endoscopic treatment of benign anastomotic colorectal stenosis with electrocautery

BACKGROUND AND STUDY AIMS: Benign anastomotic colorectal stenosis can occur after surgery and can require surgical or endoscopic dilation. This study aimed to investigate the use of electrocautery in this area. PATIENTS AND METHODS: We enrolled 39 consecutive patients (25 men, 14 women; mean age 61, range 48-77) suffering from anastomotic colorectal stenosis, demonstrated by colonoscopy (19 patients) or by barium enema (20 patients). We performed endoscopic dilation of the strictures with electrocautery once only in each patient. RESULTS: In all patients we obtained dilation of the strictures without any immediate or delayed procedure-related complications. No recurrence of the stenosis was demonstrated during a follow-up of a mean of 25 months (range 8-43 months). CONCLUSIONS: This study shows that endoscopic electrocautery is a safe and effective treatment of anastomotic colorectal stenosis.     

Traitement endoscopique par « rendez-vous » de l’obstruction complète d’une anastomose iléorectale

Benign anastomotic intestinal strictures are generally managed by endoscopic balloon dilation. Complete colonic anastomotic obstruction from benign disease is rare, with only a few reports of endoscopic management in the literature. We describe a case of successful endoscopic management of a completely obstructed ileorectal anastomosis by using a combined antegrade-retrograde endoscopic rendezvous technique.     

梗阻性左半结肠癌一期切除吻合27例分析

目的对27例左半结肠癌伴急性梗阻一期切除吻合术病例资料进行回顾性分析。方法对27例左半结肠癌伴急性肠梗阻患者行一期手术切除吻合术,术中肠腔减压,结肠灌洗,掌握适应症。结果本组资料左半结肠癌合并梗阻33例行一期切除吻合术27例,切除率81.82%。术后并发切口感染4例,吻合口瘘3例,切口裂开2例。结论只要患者病情允许,严格掌握手术适应症,术中有效的肠腔减压、灌洗,对梗阻性左半结肠癌施行一期肿瘤切除吻合的手术是可行的。     

结肠内旁路在中低位直肠癌伴急性肠梗阻保肛手术中的应用

目的 介绍结肠内旁路技术在中低位直肠癌伴急性肠梗阻保肛手术中的应用方法并评价其临床意义.方法 81例中低位直肠癌伴急性肠梗阻患者随机(随机数字法)分成两组,一组为研究组(39例):在行直肠癌低位前切除的基础上,用生物可降解吻合环及避孕套在吻合口上方5 cm处做成结肠内旁路以保护吻合口;一组为对照组(42例),在行直肠癌低位前切除术的基础上,附加预防性末端同肠造口或横结肠造口.观察两组治疗结果.结果 两组患者在性别、年龄、肿瘤位置、肿瘤大小、吻合口距肛缘距离等生理、病理因素方面差异无统计学意义(P>0.05).两组术后肠功能恢复时间均为2～5 d(P>0.05).研究组吻合口瘘发生率7.7%(3/39),吻合环自然排出时间为术后14～ 23 d(平均17 d),无引流相关并发症,术后6个月内有7.7%(3/39)的病例出现轻度吻合口狭窄;吻合口瘘者漏后引流时间平均7.1 d.对照组吻合口瘘发生率11.9%(5/42);35.7%(15/42)的病例伴有造口相关并发症,6个月后有28.6%(12/42)的病例出现吻合口轻度狭窄,7.1%(3/42)的病例出现吻合口重度狭窄,需进行松解治疗;吻合口瘘后引流时间平均18.2 d.两组吻合口瘘发生率差异无统计学意义(P>0.05).但在吻合口瘘后骶前引流管引流时间及术后6个月吻合口狭窄方面两组差异具有统计学意义(P<0.05).结论 在中低位直肠癌伴急性肠梗阻保肛手术中,与预防性回肠末端造口或横结肠造口相比,结肠内旁路技术简单、安全,可有效保护吻合口,降低了吻合口瘘带来的风险,减少了吻合口狭窄的发生率,可以推广应用.

Abstract：

Objective To introduce a novel technique of intracolonic shunt procedure used in the anus - preserving operation for acute intestinal obstruction resulted from cancer at low and middle portions of rectum and assess the clinical significance. Methods In total, 81 patients with acute obstruction of low and middle portion of rectum caused by cancer were randomly ( random number) divided into control group and study group. In control group, 42 patients were operated with preventive transverse colonostomy or terminal ileum stoma after low proximal resection of rectum involved in cancer, while 39 patients were operated with intracolonic shunt procedure by using a biodegradable anastomosis ring and a condom placed 5 cm above anastomosis for protection in study group. Results There were no significant differences in sex, age, tumor site, tumor size and the distance from anstomosis to anal-edge between two groups. In both groups, the bowel movement resumed in 2 ~ 5 days after operation (P > 0.05). In study group, the rate of anastomosis leakage was 7.7% (3/39), and leakages were treated with drainage for 7.1 days in average to be healed, and the biodegradable anastomosis ring detached and were discharged in 14 -23 days (17 days in average), and there were no complications of drainage happened. The anastomotic stenosis occurred in three patients (7. 7% ) within 6 months after operation. In control group, 11.9% patients (5/42) had anastomosis leakage and they treated with drainage for 18.2 days in average to get the leakage healed, and 35. 7% patients (15/42) had stoma complications, and anastomotic stenosis happened in 28.6% patients (12/42) within 6 months after operation, and 7. 1% patients need another operation because of severe anastomosis stenosis. There were no significant differences in rate of anastomosis leakage between tow groups ( P > 0. 05), but there were significant differences in drainage days after anstomosis leakage happened and 6 - months anastomosis stenosis between two groups (P<0.05). Conclusions In the anus -preserving operation for acute intestinal obstruction at low and middle portions of rectum caused by cancer , the intracolonic shunt procedure is convenient and safty, and reduces the hazard incurred by anastomosis leakage and anastomosis stenosis compared with classic stoma operation.     

老年低位结直肠癌并急性肠梗阻急诊一期切除临床效果分析

目的探讨老年低位结直肠癌合并急性肠梗阻急诊行一期切除吻合的可行性。方法 76例老年低位结直肠癌并发急性肠梗阻患者全部行急诊一期左半结肠或乙状结肠、直肠癌切除吻合手术。结果本组76例患者均经急诊术中结肠灌洗后行一期切除吻合。术后发生吻合口瘘3例,2例保守治疗痊愈,1例行横结肠造瘘;11例出现不同程度的炎性肠梗阻,经保守治疗后痊愈;无死亡病例;切口感染10例。结论老年低位结直肠癌并急性肠梗阻需要围手术期的综合整体治疗,急诊经术中结肠灌洗后行一期切除吻合是安全、可行的。     

内镜下扩张联合异烟肼治疗食管胃吻合口狭窄

目的探讨食管癌、贲门癌术后吻合口高度狭窄的治疗策略及疗效。方法对高度吞咽困难的78例食管癌、贲门癌术后吻合口狭窄患者行扩张治疗,单纯扩张组37例,联合治疗组(扩张+吻合口注射异烟肼+异烟肼口服)41例。两组治疗前基本状况无显著统计学差异(P>0.05)。结果两组治疗后,近期进食状况均显著改善。治疗后6个月进食降级Ⅰ级以上需再次治疗者,单纯扩张组56.76%(21/37),联合治疗组26.83%(11/41),吻合口狭窄复发率单纯扩张组明显高于联合治疗组(P<0.01)。结论扩张联合局部注射和口服异烟肼,可有效抑制狭窄口瘢痕形成,防治扩张后吻合口再狭窄,改善患者的生活质量。     

The Efficacy of the EUS for the Detection of Recurrent Disease in the Anastomosis of Colon

Patients who underwent surgical resection of an advanced colorectal cancer during the period from June 1982 to July 2001 were examined for evidence of no anastomotic recurrence or recurrent lesions through combination of endoscopic ultrasonography (EUS) with endoscopy. Included in this study were 11 patients with recurrence and 36 patients without recurrence, 47 patients in all. Endoscopy revealed stenosis in 81.8% of patients with ana anastomotic recurrence, erosion including cancer exposure in 81.8% and submucosal tumor-like elevation in 45.5%. In the group of patients without recurrence it revealed stenosis in 13.9% of patients, erosion in 22.2%, and a scar-like change in 77.8%. There was a significant difference between the two groups in each change. EUS, on the other hand, revealed localized hypertrophy of the region extending from the submucosa to the mp due to edema early in the postoperative course. The rate of definitive diagnosis with EUS was 100%, compared to 90.1% for endoscopy. The results of this study indicate that EUS is helpful in detecting anastomotic recurrence of colorectal cancer.     

Endoscopic treatment of benign anastomotic esophageal stenosis with electrocautery

BACKGROUND AND STUDY AIMS: Stricture of the esophagus following surgical resection is uncommon. Several methods have been described for treatment of this entity, but the therapeutic success may be impaired either by poor long-term results or by poor acceptance by patients. Even the high cost of the therapeutic management may represent a problem. We describe the use of electrocautery to treat benign anastomotic esophageal stenosis. PATIENTS AND METHODS: Six unselected consecutive patients (four men, two women; mean age 68.3, range 54 - 82) with stenosis following esophagojejunostomy were enrolled in this trial. Postoperative stenoses were shown endoscopically (four patients) or radiographically (two patients). We performed endoscopic dilation of the strictures using electrocautery. RESULTS: In all patients we obtained dilation of the strictures, without any immediate or delayed procedure-related complication. No recurrence of the stenosis was demonstrated during a mean 24-month follow-up (range 8 - 33 months). CONCLUSIONS: This study showed that endoscopic electrocautery is a safe and effective treatment for benign anastomotic esophageal stenosis.     

结肠癌并发急性肠梗阻患者手术时机及术式的选择对临床效果的影响

[目的]探讨结肠癌并发急性肠梗阻患者手术时机及术式的选择对临床疗效的影响.[方法]选择2016年1~11月本院收治的由结肠癌并发的急性肠梗阻60例患者,所有患者在手术方案上均采用Ⅰ期切除吻合术.根据患者病情,其中20例患者充分术前准备基础上即刻给予Ⅰ期切除吻合术(A组);20例患者保守治疗8~12 h后行Ⅰ期切除吻合术(B组),20例患者保守治疗2~3 d后行Ⅰ期切除吻合术(C组).对上述三组患者的手术情况进行统计分析,比较三组患者不同时机手术治疗的临床效果.[结果]A组、B组治疗总有效率高于C组,但组间比较差异无统计学意义(P>0.05).三组不同手术时机治疗的患者手术时间、住院时间、治愈出院及病死例数方面比较,差异均无统计学意义(均P>0.05).[结论]结肠癌并发急性肠梗阻患者只要根据的病情选择适当的手术时机行Ⅰ期切除吻合术均可取得较好的临床效果.