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。     

内镜直视下球囊扩张治疗食管狭窄21例

[目的]探讨内镜直视下球囊扩张治疗食管狭窄的疗效和安全性。[方法]经内镜直视下对21例食管狭窄患者行球囊扩张治疗,对比术前、术后狭窄部直径及狭窄程度分级,术后定期随访,观察临床症状及狭窄处直径改善情况。[结果]治疗后疗效评估为显效17例,狭窄口直径增至1．2cml有效4例,狭窄口直径增至1．0cm;总有效率100％。无一例出现食管穿孔、大出血等严重并发症。随访2年仅2例1年后复发,经2次扩张后至今未发,远期疗效达90．47％。[结论]内镜直视下球囊扩张治疗食管狭窄具有良好的临床疗效,操作简便、安全性好。     

先天性食管闭锁术后吻合口狭窄的内镜下放射状切开术联合球囊扩张术治疗初探

目的 评估内镜下放射状切开术联合球囊扩张术治疗先天性食管闭锁术后吻合口狭窄的疗效及安全性。 方法 2017年1—6月,因先天性食管闭锁术后吻合口狭窄在济南市儿童医院接受内镜下放射状切开术联合球囊扩张术治疗的患儿共4例,采用回顾性分析方法,对4例患儿的治疗及随访情况进行总结和分析。 结果 内镜下放射状切开术用时35～65 min,其中3例术程顺利,另一例术中出现呼吸困难经停止内镜操作及加压给氧后好转,4例术后3周的吞咽困难评分在2～3分,较术前的3～4分均有降低。在内镜下放射状切开术后随诊过程中,1例术后3周吞咽困难再次反复,予球囊扩张治疗后吞咽困难缓解;其余3例均在内镜下放射状切开术后3周辅以球囊扩张术1～2次,球囊扩张术过程顺利,无不良反应发生。4例随访2～3个月,上消化道造影显示造影剂可顺利通过狭窄部位,吞咽困难评分下降至0～1分。 结论 内镜下放射性切开术治疗先天性食管闭锁术后吻合口狭窄的短期疗效显著,但易出现再次狭窄,联合球囊扩张治疗后,既能做到选择性切开狭窄又能对狭窄部位瘢痕组织进行均匀扩张,从而达到更好的扩张治疗效果,同时又能有效避免穿孔并发症的发生。     

微波治疗近远期食管贲门癌术后吻合口狭窄疗效观察

食管贲门癌术后吻合口狭窄因不能进食患者会很快全身衰竭而死亡，近2a我们对1a以内术后吻合口狭窄为近期，1a～10a为远期用南京mTC—3型微波手术治疗仪经PEZTAXEG-290P电子内镜，取球形微波治疗辐射导线加大电流量90mA-100mA呈回壁点式坏死性烧灼逐渐圆形扩大狭窄的吻合口至0．5cm以上．3例近期出现进食咽下困难间断饮水呕吐经微波扩张治疗各一次，治疗后1d进流食，3d进半流食、5d少食多餐进普食以后恢复常规饮食，各观察6mo，1a吻合口均在0．9cm以上内镜通过顺利20例远期食管贲门癌术后吻合口狭窄每月或2mo微波扩张治疗一次，经反复多次治疗后狭窄的吻合口很快回复到原狭窄度，观察无明显疗效术后吻合口狭窄有多种原因，我们认为以瘢痕组织形成为主，近期吻合口狭窄由于瘢痕组织形成牢固成度差经加大电流量坏死性烧灼区（经体表微波治疗观察，坏死性烧灼面要间断连续几次脱痂的热效应期）使纤维结蒂组织逐渐坏死脱落，吻合口不在狭窄，观察疗效很好．     

内镜下球囊扩张术治疗十二指肠瘢痕狭窄疗效分析

目的观察内镜下球囊扩张术（EBD）治疗十二指肠瘢痕狭窄的近、远期疗效及影响球囊扩张疗效的因素。方法选择本院近2年收治的十二指肠瘢痕狭窄与梗阻患者，行内镜下球囊扩张术治疗，每次扩张压力为1．8、2．6、3．5atm，每种压力扩张2—3次，1周后再次扩张。结果所有患者在接受EBD治疗后症状缓解，近期疗效为97．4％，远期疗效86．8％。结论球囊扩张具有操作简单，经济有效，并发症少，近、远期疗效较好，可用于十二指肠瘢痕狭窄的治疗。     

内镜直视下置放金属支架治疗上消化道狭窄

自 1998年 7月至 2000年 9月间,我院采用全程内镜直视下预扩张、安放记忆合金支架术治疗上消化道良恶性狭窄共 12例,取得满意疗效。现报告如下。 　　1.病例选择：本组 12例中男 10例 ,女 2例;年龄 30～ 78岁,平均 65.9岁。经内镜检查及病理证实为晚期食管、贲门癌 9例,术后吻合口狭窄 2例,贲门失弛缓症 1例。狭窄位于食管下段 4例、中段 2例、贲门 3例、吻合口 2例、食管中段和贲门双重狭窄 1例。狭窄长度为 2～ 10 cm,其中 6 cm以上 7例;狭窄口径 0.3～ 0.6 cm。吞咽困难程度分为不能进水、能进流食、半流食、软食和普食五个等级…     

内镜下放射状切开术与球囊扩张术治疗食管吻合口良性狭窄的对比研究

目的比较内镜下放射状切开术与球囊扩张术治疗食管吻合口良性狭窄的疗效和安全性。方法选取2016年6月至2018年2月于阆中市人民医院就诊的49例食管吻合口良性狭窄患者,其中19例行放射状切开术治疗,30例行球囊扩张术治疗,观察治疗后1周、2个月和6个月的疗效和并发症情况。结果术后1周两组的治疗有效率均为100%;在术后2个月和6个月,放射状切开术组的有效率分别为63.2%和26.3%,球囊扩张术组分别为66.7%和24.1%,差异均没有统计学意义,两组患者均未出现出血、穿孔、感染等并发症。结论内镜下放射状切开术与球囊扩张术的疗效无明显差异,且均具有良好的安全性。     

内镜电化学治疗食管贲门癌近期疗效观察

目的 研究内镜电化学对食管、贲门癌及其术后食管胃吻合口狭窄的治疗作用。 方法 对6例食管癌、6例贲门癌及4例食管贲门癌术后食管胃吻合口狭窄患者,在纤维内镜监视导引下对癌肿及吻合口狭窄局部行电化学治疗。 结果 治疗后,6例食管癌达CR 2例,PR 3例,NC 1例总有效率83％(5/6);6例贲门癌达CR 3例,PR 3例,总有效率100％(6/6);4例吻合口狭窄明显扩张,吞咽困难明显改善。 结论 本法能使癌组织坏死,吻合口狭窄扩张,解除食管腔的机械性梗阻,使患者能经口进食。     

内镜下金属支架联合射频治疗恶性幽门梗阻的临床探讨

目前由食管恶性肿瘤所致食管梗阻已广泛采用内镜下金属支架置入治疗,但是由胃和十二指肠恶性肿瘤所致的胃窦、幽门及十二指肠球部梗阻患者支架的置入治疗报道不多.由于幽门、十二指肠经口距离远,同时胃底、胃体又有屯积缓冲作用,当这些部位的狭窄出现症状时往往已形成完全性梗阻,这对梗阻部位的球囊导管扩张和内镜下支架置入带来一定的困难.另外,支架置入后再狭窄是影响支架远期疗效的主要原因.     

食管及贲门癌术后吻合口狭窄气囊导管扩张术及预后评价

目的:评价食管和贲门癌术后吻合口狭窄气囊导管扩张术的治疗效果。方法:57例(男31例,女26例)吻合口狭窄作了气囊导管扩张术,其中食管-胃吻合54例,食管-空肠吻合3例。作1次扩张术者28例,2次扩张术者15例,3次扩张术者5例,4次扩张术者9例。全部病例均在门诊随访和作钡餐造影随访观察。结果:本组病例于末次扩张术后经2mo～36mo(平均21mo)的随访观察,疗效满意者44例(77.2％);扩张无效者13例(22.8％),给予放置金属内支架治疗。采用丝线和采用金属吻合钉吻合的两组吻合口的扩张术疗效对比无显著性意义(x~2=0.138,P>0.05);扩张术前吻合口最大舒张期直径0.2cm～0.3cm 和0.4cm～0.5cm 两组之间的疗效差异也无显著性意义(x~2=0.235,P>0.05);扩张术前吻合口长度0.2cm～0.4cm,0.5cm～1.0cm,1.1cm～4.5cm 三组之间的疗效差异有显著性意义(x~2=7.746,P<0.05)。结论:食管及贲门癌术后吻合口狭窄气囊导管扩张术简单、安全而有效,应作为首选的治疗方法。金属内支架置入可作为气囊导管扩张术无效的补救治疗措施。     

Endoscopic balloon dilation for benign esophageal anastomotic stricture: factors influencing its effectiveness.

BACKGROUND/AIMS: The aim of this study was to identify factors that might affect the results of treating benign anastomotic stricture of the esophagus with balloon dilation. METHODOLOGY: Balloon dilation was performed on 35 patients with benign esophageal anastomotic stricture of the upper (esophageal cancer: 18) or lower (gastric cancer: 15, esophageal varices: 2) esophagus. The procedure was considered effective when patients were able to maintain a solid diet more than 12 months after the last dilation. The follow-up period ranged from 15-130 months (mean: 51 months). RESULTS: A total of 245 dilations were performed, with an average of 6.6 dilations per patient. Treatment was effective in 29 patients (83%). Balloon dilation was successful when treating strictures shorter than 12 mm in length. The strictures were significantly shorter in patients treated effectively (5.6 vs. 30.8 mm). The diameter of the stricture did not affect the results. All the strictures in the lower esophagus and all those resulting from stapled anastomoses were treated successfully, while the effectiveness of treating strictures in the upper esophagus or those resulting from hand-sewn anastomoses was 67% and 57%, respectively. Strictures without prior leakage were treated effectively 92% of the time, while the success rate fell to 56% if there was a preceding leak. An average of 4.4 dilations were performed in effective cases, while the average was 17.5 dilations in ineffective cases. The number of repeat dilations was correlated with the length of the stricture. CONCLUSIONS: Balloon dilation can successfully treat strictures shorter than 12 mm long. The correlation equation may be used to predict the number of repeat dilations and treatment results, and is useful for deciding when to use an alternative method to balloon dilation.     

Percutaneous transluminal balloon angioplasty of stenotic standard Blalock-Taussig shunts: effect on choice of initial palliation in cyanotic congenital heart disease.

To date, attempted balloon dilation of stenotic standard Blalock-Taussig shunts has been largely disappointing. It has been suggested that this may be due to the use of balloons of insufficient diameter. Balloon dilation of stenotic Blalock-Taussig shunts was attempted with use of relatively large balloons in five patients (11 to 67 months old) with cyanotic heart disease who were becoming progressively cyanotic and polycythemic (hemoglobin 17.9 +/- 1.1 g/dl) because of discrete shunt stenosis at the site of pulmonary anastomosis. Balloon diameters selected were equal to or within 1 mm of the unobstructed proximal shunt diameter. Before balloon dilation the diameter at the site of the stenosis was 2.8 +/- 0.8 mm (range 1.7 to 4); after balloon dilation it was 5.7 +/- 1.1 mm (range 4.5 to 7.5). The diameter increased in all patients (range 2.0 to 3.5 mm); the mean increase was 2.8 +/- 0.2 mm (p less than 0.005). Expressed as a percent, the increase in diameter at the stenosis ranged from 80% to 182.4% (mean 108.2 +/- 16.8%). Before balloon dilation the systemic oxygen saturation was 72.8 +/- 9.2% (range 55% to 80%) and after balloon dilation it was 83.6 +/- 2.9% (range 80% to 87%). A satisfactory increase (range 6% to 25%) in blood oxygen saturation was seen in all patients; the mean increase was 10.8 +/- 3.2% (p less than 0.01). At follow-up, the oxygen saturation by pulse oximetry was 85.8 +/- 2.9% (mean 5.8 +/- 1.7 months after balloon dilation) and the hemoglobin was 15.6 +/- 1.9 g/dl (mean 6.6 +/- 1.5 months after balloon dilation).(ABSTRACT TRUNCATED AT 250 WORDS)     

纤维支气管镜下球囊扩张治疗结核性支气管狭窄的有效性与安全性

目的评价纤维支气管镜下球囊扩张治疗结核性支气管狭窄的效果和安全性。方法回顾性分析25例纤维支气管镜下行球囊扩张的结核性支气管狭窄患者，于术前和最后一次球囊扩张后估计狭窄段的气道直径，并随访评价其长期疗效。结果25例分别接受球囊扩张2—7次，平均（3．2±1．5）次。经球囊扩张后，狭窄段支气管管腔明显增大，由术前的（2．8±1．1）mm增加为术后的（6．7±2．3）mm，即时疗效达100％，所有患者均未发生严重并发症，经过2—36个月的随访，未发生狭窄段的明显再狭窄。16例随访超过1年的患者，距最后一次扩张1年后气道直径为（5．5±2．0）mm，与最后一次扩张后气道直径无明显差别，比扩张前气道直径明显增加。出现肺不张的11例经球囊扩张后有2例完全复张。结论纤维支气管镜下球囊扩张治疗结核性支气管狭窄具有有效、安全和简便等优点。     

球囊扩张术治疗结核性气道狭窄的疗效评价

目的探讨球囊扩张术治疗结核性气道狭窄的价值。方法15例结核性气管和支气管狭窄病人,经临床、肺功能评价后,在透视下经纤维支气管镜进行气道球囊扩张术,每周扩张1次,连续3次,多叶狭窄病例采用分段扩张法,评价气道开放、近期疗效和肺功能改善情况。结果15例病人共扩张50次,平均3．3次,气道开放为90．6％,气道直径在扩张前后有显著性差异(t=6．783 0,P＜0．05),扩张后肺功能有明显的改善(t=5．152 7,P＜0．05);6个月内再狭窄率为18％,4例支气管狭窄合用支架。结论球囊扩张术对以纤维疤痕为主的气道狭窄疗效好,以肉芽增生为主的气道狭窄应多次扩张,必要时并用其他手段。球囊扩张术治疗结核性气道狭窄是气道开放、改善肺功能的较好介入手段。     

Treatment of pulmonary artery stenosis after arterial switch operation: stent implantation vs. balloon angioplasty.

The development of pulmonary artery stenosis is a potential complication during the mid- to long-term follow-up after arterial switch operation (ASO) for transposition of the great arteries. Surgical results have been disappointing and conventional balloon dilation yields a fairly important incidence of failures and recurrences. We evaluated our results with implantation of balloon-expandable stents in 5 out of 13 patients with a previously attempted unsuccessful conventional balloon dilation of pulmonary artery branch stenosis after ASO. In two more cases, stents were used as a primary procedure. Balloon angioplasty achieved a 15% increase in mean diameter of the stenosis vs. 124% with the use of stents (P< 0.01), a 10% decrease of the pressure gradient across the stenosis vs. 71% of stents (P<0.01), and a 10% drop in RV/aorta pressure ratio vs. 43% of stents (P<0.01). Compared to conventional balloon angioplasty in our series, stents were more effective in the treatment of patients with peripheral pulmonary artery stenosis after ASO. Balloon dilation should be considered in selected cases unsuitable for treatment with endovascular stents.     

Balloon dilation of postoperative right ventricular outflow obstructions

Balloon dilation was attempted in 16 patients, aged 5 months to 19.5 years, with right ventricular outflow obstruction after repair of congenital heart defects. Stenosis of a valved conduit between the pulmonary ventricle and pulmonary artery was present in nine patients with a mean transvalvular peak systolic ejection gradient of 61.6 +/- 21.0 mm Hg and a mean right ventricle to aorta pressure ratio of 0.9 +/- 0.2. Supravalvular pulmonary stenosis was present in seven patients; in five, stenosis was at the anastomotic site after the arterial switch operation with a mean peak systolic ejection gradient of 72.2 +/- 10.6 mm Hg and mean right ventricle to aorta pressure ratio of 0.93 +/- 0.05. The other two patients had stenosis at a previous pulmonary artery band site with a peak systolic ejection gradient of 60 and 65 mm Hg and right ventricle to aorta pressure ratio of 0.75 and 0.72, respectively. Balloon dilation was successful in three of nine patients with a valved conduit; two of them had additional successful balloon dilation of the right pulmonary artery. In five of the nine patients (including one with successful dilation) the conduit was replaced 5.7 +/- 4.5 months after balloon dilation. Balloon dilation was successful in only one of the five patients with supravalvular pulmonary stenosis after the arterial switch operation and partially successful in the two patients with supravalvular pulmonary stenosis at a previous band site. The success rate of balloon dilation of postoperative right ventricular outflow obstruction is much lower than that for other right heart obstructions.     

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3～24 cm（中位距离6 cm）。10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20 mm,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。     

Double balloon technique for dilation of valvular or vessel stenosis in congenital and acquired heart disease

Despite the generally excellent success with balloon dilation for the stenotic lesions of congenital and acquired heart disease, technical difficulties sometimes prevent satisfactory results. Such technical difficulties include: a large diameter of the anulus of the stenotic lesion relative to available balloon diameter, difficulty in the insertion or removal of the larger balloon catheters, and permanent damage to or obstruction of the femoral vessels by the redundant deflated balloon material of the large balloons. A double balloon technique was initiated to resolve these difficulties. With this method, percutaneous balloon angioplasty catheters were inserted in right and left femoral vessels, placed side by side across the stenotic lesion and inflated simultaneously. Dilation procedures using the two balloon technique were performed in 41 patients: 18 with pulmonary valve stenosis, 14 with aortic valve stenosis, 5 with mitral valve stenosis, 3 with vena caval obstruction following the Mustard or Senning procedure and 1 with tricuspid valve stenosis. Patient ages ranged from 1 to 75 years (mean 17.8) and patient weights ranged from 8.9 to 89 kg (mean 42.3). Balloon catheter sizes ranged from 10 to 20 mm in diameter. Average maximal pressure gradient in mm Hg before dilation was 61 in pulmonary stenosis, 68 in aortic stenosis, 21 in mitral stenosis, 12 in tricuspid stenosis and 25 in vena caval stenosis. Average maximal valvular pressure gradient after dilation was 13 in pulmonary stenosis, 24 in aortic stenosis, 4 in mitral stenosis, 0 in tricuspid stenosis, and 1 in vena caval stenosis. No major complications were encountered with the procedures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Treatment of Peripheral Pulmonary Stenoses

Background: Peripheral pulmonary artery stenosis is a relatively frequent anomaly responsible for right ventricular hypertension, significantly affecting the quality of life and the long-term prognosis of patients with congenital heart disease. Balloon angioplasty has been used to relieve pulmonary artery stenosis, but immediate and long-term results have not been completely satisfactory. Conversely, stent implantation seems a promising and more effective technique for the treatment of this vascular anomaly. Methods: Between April 1987 and September 1997, indication for interventional cardiac catheterization has been estabilished for 150 patients. Balloon angioplasty was performed in 120 patients (162 procedures) and stent implantation in 60 patients (79 stents). In 30 patients, both procedures have been carried out. Indication was based on the presence of right ventricular hypertension (right ventricular/systemic peak systolic pressure ratio ≥ 0.5), right ventricular dysfunction, or a markedly unbalanced pulmonary blood flow, especially after bidirectional cavopulmonary anastomosis. Criteria for technical success of balloon dilation were defined as a ≥ 50% increase in the predilation diameter, a ≥ 50% decrease in the transstenotic pressure gradient, or a ≥ 20% decrease in the right ventricular-to-aortic pressure ratio. Mean balloon/stenosis diameter ratio was 3.0 ± 0.7 (range 1.8–4.2). Time between primary surgery/balloon angioplasty and stent implantation was 18 ± 7 months (range 8–21 months). Stainless steel balloon-expandable endovascular stents were maximally dilated to 12–18 mm of diameter, and high-pressure dilations were performed to further expand the stent, if necessary. Results: After balloon angioplasty, the diameter of the stenotic segment increased from 3.1 ± 0.3 to 5.1 ± 1.4 mm (P < 0.01), the gradient across the stenotic segment dropped from 51 ± 19 to 28 ± 8 mmHg (P < 0.01), and the right ventricular/systemic peak pressure ratio decreased from 0.81 ± 0.20 to 0.65 ± 0.15 (P < 0.05). No significant difference between procedures with low-pressure and high-pressure dilation was recorded. Success rates using the above-mentioned criteria could be assessed as high as 60%. After stent implantation, the diameter of the stenotic segments increased from 3.5 ± 1.2 to 13.2 ± 3.4 mm (P < 0.01), the pressure gradient across the stenotic segment dropped from 53 ± 30 to 13 ± 10 mmHg (P < 0.01), and the mean right ventricular/systemic pressure ratio decreased from 0.84 ± 0.2 to 0.40 ± 0.15 (P < 0.01). Immediate overall success for balloon angioplasty was achieved in 73 of 120 patients compared with 58 of 60 patients submitted to stent implantation (60% vs 97%, P < 0.001). The complication rate was 6.9% (5/162 procedures) in the balloon angioplasty group and 1.2% (1/79 implants) in the stent group. Restenosis has been recorded in 25% of the balloon group patients, in respect to 2% of the stent group. Conclusions: Peripheral pulmonary stenosis (PPS) is an important factor conditioning outcome of patients with congenital heart defects. Balloon angioplasty may be technically effective, but it often fails if clinical criteria and impact on patient's outcome are considered. In our experience, the use of high-pressure balloons did not change the success rate of balloon dilation. Stent implantation seems to offer a better and more definitive approach for the relief of PPS.