食管吻合口狭窄气囊导管扩张术与放置内支架疗效对比

目的对比评价食管贲门癌术后吻合口狭窄单纯气囊导管扩张术与辅以食管支架置入术的治疗效果。方法两种病例共103例吻合口狭窄均作了气囊导管扩张术,其中79例作单纯气囊导管扩张术,24例作气囊导管扩张术辅以支架置入术(5例为裸支架,19例为覆膜支架)。结果全部103例作单纯气囊导管扩张术后经4～38个月随访观察,有效者79例,占76.7%;另24例扩张无效者辅以放置食管支架,经4～38个月随访,有效者17例,有效率70.8%;与单纯作气囊导管扩张术比较差异无统计学意义(χ2=0.36,P>0.05)。结论食管贲门癌术后吻合口狭窄,应以气囊导管扩张术作为首选的治疗方法,气囊导管扩张无效者再考虑辅以放置食管支架作为治疗的补救措施。

The management of anastomotic stricture occurred after esophagectomy: a comparison between balloon dilation alone and balloon dilation together with stent placement

Objective To compare the clinical effectiveness of balloon dilation alone with that of balloon dilation together with stent placement in treating anastomotic stricture occurred after esophagectomy for esophagocardial cancer.Methods A total of 103 patients with anastomotic stricture occurred after esophagectomy were enrolled in this study.Simple balloon dilatation was performed in 79 patients,while balloon dilatation combined with stent implantation was carried out in 24 patients.Bare-metal stent was employed in 5 cases,and covered stent was used in 19 cases.The results were compared between the two therapies.Results Technical success was achieved in all patients.Simple balloon dilatation was carried out in all 103 patients.The patients were followed up for 4 ～ 38 months,effective result was obtained in 79 cases(76.7%).No improvement was seen in the remaining 24 cases,and additional stent implantation had to be carried out.During the follow-up period of 4 ～ 38 months,17 cases(70.8%) responded to the stenting therapy.No statistically significant difference in the effective rate existed between the two therapies(χ2 = 0.36,P > 0.05).Conclusion For the treatment of anastomotic stricture occurred after esophagectomy for esophagocardial cancer,simple balloon dilatation should be regarded as the treatment of first choice,and additional stent placement can be employed when balloon dilatation is used in vain.