内镜治疗上消化道狭窄的几点体会——附70例报告

本文报告了我院1989年9月～1993年6月在内镜下用高频电、激光、微波扩张法(简称光电扩张法)及经内镜通道气囊(Regiflex TTS气囊)及自制与内镜平行送入的大气囊扩张法治疗70例上消化道狭窄,收到良好效果.作者经回顾总结,谈几点粗浅体会.     

内镜下哑铃型气囊导管扩张器治疗食管贲门狭窄的临床研究

目的 探讨内镜下治疗食管贲门狭窄的新方法。方法 对食管贲门狭窄病人40例实施内镜下哑铃型气囊导管扩张器治疗。结果 40例中除1例扩张失败外，余39例狭窄程度均得到了不同程度改善，总有效率97．5％。结论 内镜下哑铃型气囊导管扩张器治疗食管贲门狭窄是一种有效的治疗途径，值得临床推广。     

内镜下探条联合气囊或电刀扩张食管贲门狭窄疗效观察

目的 探讨多种扩张方法在食管贲门狭窄治疗中的优缺点。方法 单独或联合采用Savary—Gimard扩张器、扩张气囊、高频针式电刀对43例食管贲门狭窄病人进行治疗，并观察临床疗效。结果 单独采用S法28例，5例失败，有效率82．1％，治疗失败的5例病人改用联合扩张气囊或高频电刀治疗后，4例成功，总有效率提高到96．4％。结论 临床根据病人狭窄的病因、特点灵活选择扩张方法可明显提高疗效，减少病人痛苦和并发症。     

经内镜治疗结肠狭窄

作者在十年中内镜治疗14例结肠狭窄患者,平均年龄62岁。狭窄部位为乙状结肠(12例),直肠(2例)。狭窄原因分别为吻合术后(7例)、吻合口复发癌(3例)、原发癌(1例)、炎症性肠病、子宫内膜异位造成的腔外压迫及非特异性病变(各1例)。扩张方法:有探条扩张术,特殊的扩张型内镜,经内镜气囊扩张术及单极电切、激光手术。扩张型内镜前端直径为9.5 mm,插入管外径为13 mm。其之间可接上13.6～24 mm橄榄形扩张器。气囊扩张器是由4～25 mm的气囊组成,附有压力传感器和监视器,在X线荧光屏监视下,把附有气囊导管插入扩张狭窄部。治疗前,先作钡剂灌肠和结肠镜检查,必要时将导管插入狭窄部注入造影剂,观察狭窄大小和形态,选择     

食管支架置入后再狭窄的内镜治疗疗效观察

食管贲门及吻合口良恶性狭窄置入金属食管支架后能有效解除患者的吞咽困难，改善生活质量，延长生存期。但支架置入后再狭窄的发生率较高，约束了其广泛应用。我院自1998年至2002年对食管贲门及吻合口良恶性狭窄患者置入食管支架共54例，13例出现了支架置入后再狭窄，经内镜下高频电切、微波烧灼，探条扩张或再次置入支架治疗后取得一定的疗效，现报道如下。     

内镜高频电、激光及微波治疗胃肠道息肉的对比

目的对比内镜高频电、激光及微波治疗胃肠道息肉的疗效观察．方法选用我院自1985／1998间，在内镜高频电切除食管、胃、十二指肠息肉37例，43枚；切除结肠息肉87例，121枚；内镜下激光切除胃息肉15例，26枚；结肠息肉4例，5枚；内镜下微波切除胃息肉12例，14枚；结肠息肉14例，20枚．共169例，229枚．各组年龄、性别无明显差异．息肉分布在上消化道息肉以鲁多发，在结肠以直肠、乙状结肠多发病理特点以炎性增生性息肉为多见．结果高频电组：一次或分次切除息肉，成功率在98％．15d后复查，118／164枝形成溃疡，占71．95％．激光组：小的息肉一次可切除，大的息肉成功率为50％，15d后复查，18／31枚形成溃疡，占58．06％．微波组：一次切除率1cm以下达100％，2cm以上为50％．15d后复查，18／34枚形成溃疡，占52．94％．结论胃肠道息肉好发部位为胃及直肠、乙状结肠，以炎性增生性息肉为多见．切除方法，对较大、有蒂息肉以高频电凝电切为恰当，较小、无蒂息肉选用激光或微波治疗为宜．     

内镜下高频电切联合激光治疗颈段食管癌支架置入术后再发狭窄15例

目的: 探讨内镜下高频电切联合激光治疗颈段食管癌支架置入术后再发狭窄的疗效及安全性.方法: 本组15例患者经胃镜检查, 病理细胞学证实为食管恶性肿瘤, 颈段食管癌支架置入术后再发狭窄, 癌肿上段距门齿16-20 cm; 隆起型病变采用内镜下高频圈套电切清除, 管状浸润性狭窄病变或不能圈套病变联合激光治疗, 并观察治疗前后食管直径大小、狭窄程度改善.结果: 15例患者均成功, 术后12 h顺利进食, 无1例发生食管大出血、穿孔并发症, 治疗术前狭窄管腔直径约4±2 mm, 术后约13.5±2mm, 1 mo后完全有效11例, 显著效应3例, 有效应1例, 无效应0例, 有效率100%.结论: 内镜下高频电切联合激光治疗食管上段癌支架置入术后再发狭窄, 是目前治疗食管狭窄安全、有效的方法之一.     

内镜微波凝固扩张后置管治疗食管良恶性狭窄

１９９２年始我们采取内镜微波凝固扩张后放人内置管，治疗食管重度良恶性狭窄２５例，取得了较好的疗效，现报告如下。一、病例选择：２５例食管狭窄男18，女７，中位年龄５１岁。狭窄原因：食管鳞癌３例，吻合口复发癌５例，吻合口疤痕狭窄１７例。狭窄程度３度１９例，４度６例４例依赖空肠造瘘维持营养，２１例需反复扩张或微波治疗。二、器材：纤维食管镜、微波内镜治疗仪、导丝、自制硅胶内置管，内径１．０ｃｍ，外径１．３ｃｍ，长５～１５ｃｍ，上端呈漏斗状，下端山慈菇形，中间有一气囊，可经细导管充气膨胀。三、方法：１．内镜…     

大肠息肉的内镜微波、高频电治疗

1996－05／1998－05应用纤维结肠镜检查患者1205例，检出各种息肉127例，高频电凝切及微波电灼286枚，疗效满意，现报告如下．1对象和方法1．1对象127例患者中，男76例，女51例，年龄4岁～79岁，平均44．5岁，以40岁以上者居多．所有病例均有程度不同的下腹或左下腹痛，粘液便32例，粘液血便53例．病程2d～16a年．1．2方法CT－301型纤维结肠镜，配以SD－20型高频电治疗仪和WS－ⅡD多功能微波治疗仪．操作方法按内镜检查及大肠息肉电凝切的常规进行．对山田Ⅰ，Ⅱ型息肉采用微波凝固治疗，对山田Ⅲ，Ⅳ型息肉采用高频电凝切除，对特大不规…     

食管重建术后并发症的内镜诊断和处理

目的 对食管重建术后患者的上消化道病变进行内镜诊断和治疗。 方法 食管重建患者54例,术后3周-3年进行内镜随访检查。 结果 残余食管、吻合口和代食管病变的发生率分别为11.6％,69.0％和27.8％。食管重建后患者最常见的疾病为非特异性残余食管炎、吻合口炎及不同程度的吻合口狭窄和慢性胃炎。对5例吻合口重度狭窄患者成功地进行了内镜下吻合口狭窄切开或切开 扩张治疗。 结论 内镜检查有助于食管重建术后并发症的诊断,对作咽造口 食管旁路术患者也是安全可行的。对某些严重吻合口疤痕狭窄者内镜下电切 扩张治疗可解除症状。     

食管吻合口良性狭窄治疗方法的临床进展

食管恶性肿瘤术后,食管吻合口狭窄是常见的并发症,其严重影响患者生活质量,主要表现为吞咽困难,严重者无法进食,食管吻合口狭窄可分为良性狭窄和恶性狭窄。良性狭窄治疗方法可分为几类：吞咽康复训练、内镜下药物局部注射、微波凝固治疗,球囊扩张术、食管支架植入术、内镜下切开治疗、联合治疗;恶性狭窄主要通过手术方式进行治疗。本文对食管吻合口良性狭窄治疗方法的研究现状作一综述。     

Usefulness of biodegradable stents constructed of poly-l-lactic acid monofilaments in patients with benign esophageal stenosis

AIM: To report 13 patients with benign esophageal stenosis treated with the biodegradable stent. METHODS: We developed a Ultraflex-type stent by knitting poly-l-lactic acid monofilaments. RESULTS: Two cases were esophageal stenosis caused by drinking of caustic liquid, 4 cases were due to surgical resection of esophageal cancers, and 7 cases were patients with esophageal cancer who received the preventive placement of biodegradable stents for post- endoscopic mucosal dissection (ESD) stenosis. The preventive placement was performed within 2 to 3 d after ESD. In 10 of the 13 cases, spontaneous migration of the stents occurred between 10 to 21 d after placement. In these cases, the migrated stents were excreted with the feces, and no obstructive complications were experienced. In 3 cases, the stents remained at the proper location on d 21 after placement. No symptoms of re-stenosis were observed within the follow-up period of 7 mo to 2 years. Further treatment with balloon dilatation or replacement of the biodegradable stent was not required. CONCLUSION: Biodegradable stents were useful for the treatment of benign esophageal stenosis, particularly for the prevention of post-ESD stenosis.     

Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions

BACKGROUND: Although bleeding and perforation are generally recognized major complications of endoscopic mucosal resection, esophageal stricture after endoscopic mucosal resection has not been well studied. Factors associated with the occurrence and severity of esophageal stenosis after endoscopic mucosal resection were investigated. METHODS: Two hundred sixteen superficial esophageal lesions in 137 consecutive patients who underwent endoscopic mucosal resection from February 1993 through March 2001 were retrospectively studied. The circumferential extent of the mucosal defect after endoscopic mucosal resection was classified into 4 groups: under one fourth, one fourth to one half, one half to three fourths, and over three fourths. The longitudinal length of the mucosal defect was also evaluated. Stenosis was diagnosed when a standard endoscope (11-mm diameter) could not be passed through the stricture. RESULTS: Esophageal stenosis developed after endoscopic mucosal resection of 13 lesions (6.0%). In all these cases endoscopic mucosal resection resulted in a mucosal defect that involved over three fourths of the luminal circumference. In the subgroup of patients with mucosal defects involving over three fourths of the circumference, those with a mucosal defect over 30 mm long required more frequent balloon dilatation (mean 8 [4.3] times) and the stenosis was of longer duration (mean 16 [17.7] months) than those with defects 30 mm or less in length (respectively, 1 [0.6] times and 2 [1.9] months). CONCLUSIONS: A circumferential mucosal defect involving over three fourths the circumference of the esophagus after endoscopic mucosal resection was significantly associated with the subsequent development of esophageal stenosis. In addition, mucosal defects longer than 30 mm were associated with greater severity of stenosis. When endoscopic mucosal resection is performed for superficial esophageal lesions, removal of excess mucosa should be avoided.     

Incidence, clinical management and outcomes of esophageal perforations after endoscopic dilatation

BACKGROUND: Esophageal dilatation is performed for the treatment of anatomic and sometimes functional narrowing of the esophageal lumen caused by a variety of benign and malignant conditions. Esophageal perforation is the major complication associated with endoscopic dilatation. AIM: The object of this study was to assess the incidence of perforation, management and outcomes after endoscopic esophageal dilatation. METHODS: All patients who underwent endoscopic esophageal dilatation at our institution from June 2001 to December 2006 were identified. Data were obtained by searching our prospectively collected electronic database (MEDOS AG, Langenselbold, Germany), which includes all endoscopic reports as well as discharge summaries of patients who have undergone endoscopy in our department. RESULTS: 248 patients (148 male, 100 female, mean age 58 years, range 14-87 years) underwent 365 esophageal dilatations: 74 pneumatic balloon dilatations for achalasia, 79 balloon dilatations for other reasons such as tumors, peptic stenosis, or post-radiotherapy stenosis and 212 dilatations with Savary bougies. The overall incidence of perforation based on the number of procedures was 2.2% (8 perforations/365 procedures) and 3.2% (8/248 patients) based on the number of patients. The perforation rate was 1.9% for bougie dilatation, 0% for balloon dilatation and 5-4% for pneumatic balloon dilatation for achalasia. Five patients were treated surgically and 3 patients were managed conservatively. The mean hospital stay was 14 days (7-33 days). One patient in whom the perforation was recognized 16 days after the dilatation died. CONCLUSIONS: Endoscopic esophageal dilatation is a safe procedure for the palliation of malignant strictures, for the management of benign strictures as well as for the therapy of achalasia. The perforation rate after these procedures is low. Early recognition of the perforation is associated with a good outcome. Small perforations can be treated conservatively.     

Usefulness of biodegradable stents constructed of poly-l-lactic acid monofilaments in patients with benign esophageal stenosis

AIM： To report 13 patients with benign esophagea stenosis treated with the biodegradable stent.
METHODS： We developed a Ultraflex-type stent by knitting poly-/-lactic acid rnonofilaments.
RESULTS： Two cases were esophageal stenosis caused by drinking of caustic liquid, 4 cases were due to surgical resection of esophageal cancers, and 7 cases were patients with esophageal cancer who received the preventive placement of biodegradable stents for postendoscopic mucosal dissection （ESD） stenosis. The preventive placement was performed within 2 to 3 d after ESD. In 10 of the 13 cases, spontaneous migration of the stents occurred between 10 to 21 d after placement. In these cases, the migrated stents were excreted with the feces, and no obstructive complications were experienced. In 3 cases, the stents remained at the proper location on d 21 after placement. No symptoms of re-stenosis were observed within the follow-up period of 7 mo to 2 years. Further treatment with balloon dilatation or replacement of the biodegradable stent was not required.
CONCLUSION： Biodegradable stents were useful for the treatment of benign esophageal stenosis, particularly for the prevention of post-ESD stenosis.     

Postoperative Duodenal Stenosis as an Early Complication Following Laparoscopy‐Assisted REsection of Transverse Colon Cancer: Report of Successful Endoscopic Balloon Dilatation

A 69‐year‐old man underwent laparoscopy‐assisted resection for transverse colon cancer. He visited our department approxiately 1 month after operation suffering from nausea and epigastric discomfort. Endoscopy and X‐ray examina‐tion showed a severe stenosis in the second portion of the duodenum, which we believe was caused by the previous colectomy as indicated by no evidence of other causative event or factor found in his history or through thorough examination. He was then successfully treated by endoscopic balloon dilatation using of a controlled radial expansion wire‐guided balloon dilatation catheter. We report a case of postoperative duodenal stenosis as an early complication following laparoscopy‐assisted resection of transverse colon cancer. This case would be the first report documented in Japan that we are aware of. Furthermore, this experience suggested that endoscopic balloon dilatation for postoperative duodenal stenosis is effective.     

自体皮片移植术预防食管环周早癌内镜黏膜下隧道剥离术后食管狭窄的临床研究

目的 评价自体皮片移植术预防食管环周早癌内镜黏膜下隧道剥离术（ESTD）后食管狭窄的安全性和有效性。方法 2018年1月至2018年3月,5例食管环周早癌患者于解放军总医院接受ESTD联合自体皮片移植术。术后通过内镜随访,观察皮片生长情况,有无食管狭窄及并发症发生情况。结果 5例患者均成功实施了食管环周早癌ESTD和自体皮片移植术。无食管穿孔、出血、创面感染和支架移位等并发症发生。平均移植皮片成活率为86.0%。4例患者术后平均随访9.5个月,未发生食管狭窄;1例患者术后发生食管狭窄并进行了球囊扩张,术后随访8个月内未再发生狭窄。结论 自体皮片移植术可能是预防食管环周早癌ESTD术后食管狭窄的一种安全且有效的方法。     

小儿食道化学性碱烧伤狭窄的内镜下气囊扩张治疗分析

目的探讨新疆地区小儿食道化学性烧伤狭窄的特点和内窥镜下气囊扩张治疗的安全性及临床价值。 方法收集2009年1月至2017年10月,新疆维吾尔自治区人民医院20例食道化学碱烧伤狭窄的患儿术前通过消化道造影及胃镜检查诊断的临床资料,本组患者均采用胃镜下气囊扩张食道术。 结果本组患者均胃镜下气囊扩张手术成功,食道穿孔0例,死亡0例,17例（85%）扩张术后再次出现进食困难及呕吐等食道狭窄症状,扩张治疗2~12次,平均3.7次／例,3例（15%）第1次扩张术后治愈。 结论化学腐蚀剂灼伤粘膜及肌层,碱性液可渗透食道全层,肌层受损,出现瘢痕狭窄,严重者出现完全梗阻。本组食道狭窄的患儿均选用胃镜下气囊扩张术,直视下进行操作是安全,无辐射性,治疗有效满意。     

Novel Biodegradable Stents for Benign Esophageal Strictures Following Endoscopic Submucosal Dissection

The application of metallic stents for benign stenosis is limited due to long-term complications. We report here the results of the implantation of a novel biodegradable poly-l-lactic acid (PLLA) esophageal stent in two patients with benign esophageal stenosis after endoscopic submucosal dissection (ESD). Case 1 was a 64-year-old man who received ESD for an early squamous esophageal cancer in the middle esophagus. The mucosal defect was seven-eighths of the circumference, and the distal margin of the resection scar formed the stenosis. After balloon dilatation, the PLLA esophageal stent was endoscopically placed; for 6 months, he has not experienced any symptoms of re-stenosis. Case 2 consisted of a 62-year-old man who developed an early squamous esophageal cancer in the middle esophagus. The lesion was resected by ESD, and the mucosal defect was seven-eighths of the circumference. The resection scar formed the stenosis, and the PLLA esophageal stent was endoscopically placed. He also has not experienced any symptoms of re-stenosis for 6 months. In conclusion, the PLLA esophageal stent provides a new possibility for the management of benign esophageal strictures after ESD. Due to the biodegradable features of this stent, longer term studies are necessary to investigate the relationship between the expected disappearance of the stent and the patency of the stricture.     

大疱性类天疱疮并食管狭窄6例临床分析

回顾性总结我院2001年4月～2011年9月10年间共诊治的6例大疱性类天疱疮并食管狭窄患者的病历资料,对6例患者全部采用口服糖皮质激素治疗,其中对于药物治疗后症状改善不明显的3例患者实施了内镜下球囊扩张治疗,结果显示,6例患者的食管狭窄均逐渐改善,且无上消化道出血、穿孔等严重并发症发生。因此,我们认为,口服糖皮质激素并辅助以内镜下球囊扩张治疗大疱性类天疱疮并食管狭窄简便易行、安全有效。