Oddi括约肌狭窄的诊断与治疗

本文通过对３７５例胆囊、胆总管结石患者术后有残留症状者，经Ｂ超、ＥＲＣＰ、Ｔ管造影诊断为Ｏｄｄｉ括约肌狭窄者１６７例，均经十二指肠镜乳头括约肌切开（ＥＳＴ）治愈。同时讨论了Ｏｄｄｉ括约肌狭窄的原因、临床表现及诊断治疗中注意事项。     

静脉麻醉用于内镜引导沙氏探条扩张治疗食管癌术后狭窄的临床研究

目的：探讨在无痛状态下内镜引导沙氏探条扩张治疗食管癌术后狭窄的安全性与临床疗效。方法：将220例食管癌手术或放射治疗后出现狭窄患者分为两组，115例静脉麻醉后进行扩张患者为麻醉组，同期105例未采用静脉麻醉进行扩张患者为对照组，比较两组扩张效果及安全性。结果：麻醉组中原狭窄部孔隙平均口径0．35cm，平均扩张2，4次／人，平均治疗0，6个疗程／人，扩张6周后112例狭窄部口经〉0．8era，吞咽困难得到改善，有效率97．4％，其中显效为62．6％，3例无效，占2．6％。9例扩张时血氧饱和度〈80％（Ⅰ度），6例扩张后出现黑便。1年后80例回访，3例狭窄部口径〈0．8cm，出现吞咽困难。对照组中原狭窄部孔隙平均口径0．36cm，平均扩张3，4次／人，平均治疗0．85个疗程／人，扩张6周后99例狭窄部口经〉0.8cm，吞咽困难得到改善，有效率94.3％，其中显效为30．5％，6例无效，占5.7％。1例扩张后出现气胸，2例扩张后出现黑便。1年后72例回访，11例狭窄部口径〈0．8cm，出现吞咽困难。结论：静脉麻醉与非静脉麻醉状态下用沙氏探条扩张治疗食管癌术后狭窄均安全有效，但前者疗程短，远期疗效更理想。     

Successful new treatment for intractable cervical esophageal stenosis of a jejunal segment transpositioned with a vascular anastomosis: report of a case

Strictures of the alimentary tract are conventionally treated by fluoroscopically guided bouginage and endoscopic balloon dilation, which is often very effective. However, severe and recurrent stenosis associated with ischemic injury in a jejunal segment transpositioned with a vascular anastomosis after reconstruction for cervical esophageal cancer is an intractable problem. We describe a new method using a Steno-Cutter to successfully treat a patient with this type of stricture following surgery for cervical esophageal cancer. The positive results achieved in this case suggest that our new method could represent a promising option of treatment for strictures when conventional modalities fail. Received: October 25, 2001 / Accepted: May 7, 2002 Acknowledgment. This work was supported in part by the 29th award from the Japanese Society for Advancement of Surgical Techniques. Reprint requests to: S. Shimada     

内支架在上胃肠道良恶性狭窄治疗中的应用

目的探讨带膜镍钛记忆合金网状支架在治疗晚期上胃肠道癌上胃肠道狭窄中的价值。方法本组33例,在日立TU-41 500 mA X线电视监视下,用交换导丝、Cobra导管引入超硬导丝,将支架置入病变段。结果33例共置入支架40枚,成功率100%。患者吞咽困难及上胃肠道梗阻症状明显改善和解除,未出现上胃肠道穿孔、大出血或死亡等严重并发症。结论带膜镍钛记忆合金支架治疗晚期上胃肠道癌上胃肠道狭窄安全有效。     

Colonic tuberculosis mimicking annular carcinoma: Report of a case

Tuberculosis of the colon may be difficult to distinguish from Crohn's diseases or other causes of benign or malignant stricture, but rarely is seen as a classic solitary “apple-core” lesion on barium-enema examination. Such a case is presented, and the radiologic and pathologic features discussed.     

Etiology of colonic strictures in South African black and Indian patients

The etiology of colonic strictures in 263 South African black and Indian patients is presented. Nonmalignant lesions accounted for strictures in two-thirds of the patients and included amebiasis (27), tuberculosis (24), nonspecific colitis (30), ulcerative colitis/Crohn's colitis (11) and other lesions (36). Malignant lesions caused strictures in approximately a third of the black and Indian patients, which is higher than in other reported series in blacks. Accurate clinical diagnosis is difficult and early histologic confirmation is mandatory in order to institute rational management. Strictures of the right colon in the black population are more likely to be benign, except in younger patients. Leftsided colonic strictures have an equal chance of being benign or malignant, and early histologic confirmation is essential. The coexistence of an underlying malignant lesion in association with an inflammatory lesion in an endemic area should always be considered, particularly if it fails to respond to empirical therapy within a short period of time.     

Balloon dilatation in children for oesophageal strictures other than those due to primary repair of oesophageal atresia,interposition or restrictive fundoplication

Background Balloon dilatation of the oesophagus in children has been performed predominantly for treating strictures, which are the result of primary repair of oesophageal atresia, interposition surgery or restrictive Nissen's fundoplication. Reports of the use of this technique for alternative causes of stricture are few.Objective To report our experience and success with balloon dilatation of strictures due to caustic ingestion, achalasia, oesophagitis, congenital stenosis, and epidermolysis bullosa (EB) and to make comparisons with our treatment of patients with primary repair of oesophageal atresia (OA), as well as with reports in the English language literature.Materials and methods Retrospective review of fluoroscopically guided balloon oesophageal dilatation procedures in 19 patients over a 5-year period, and comparison of those performed for OA repair complications with those due to other diseases. The average radiation dose, per procedure, was calculated by a medical physicist.Results Ten patients had strictures as a result of primary repair of OA. Three patients had stricture as a result of EB, two from achalasia, two from caustic injury, one due to an oesophageal web and one from reflux oesophagitis. Our results show that the technique can also be curative for the last group and that it may be used intermittently to alleviate symptoms in ongoing diseases. We have not experienced any complications and have also calculated that, even with prolonged use of multiple procedures, the radiation exposure is comparable to other radiological techniques.Conclusions Patients with alternative causes for oesophageal stricture may be treated to resolution within 2 years using balloon dilatation. Ongoing diseases such as EB require ongoing dilatation, but balloon dilatation of strictures has been successful in alleviating swallowing difficulty. Patients with stricture from OA repair sometimes need ongoing dilatation. Radiation exposure for multiple procedures, over an extended period, is comparable to that from a single abdominal CT, and can be considered acceptable when repeat complex surgery is the alternative treatment option, or when ongoing incurable disease is the cause of the stricture.This paper was presented in a modified form at the 39th Annual Congress of ESPR, Bergen, Norway, June 2002     

Pseudohypospadias with bilateral vesicoureteric reflux: consequences of inappropriate management of stricture urethra

A 17-year-old male boy presented with clinical features of pseudohypospadias (small penile stump with absent distal penile urethra) associated with very small capacity bladder and bilateral grade IV vesicoureteric reflux following suprapubic urinary diversion for multiple urethro-cutaneous fistula and periurethral abscess which developed as a consequence of inappropriate initial management of urethral trauma. This case highlights the importance of the initial management of urethral trauma and the management of its rare complication.     

内镜下金属支架置入术治疗上消化道狭窄79例疗效分析

目的探讨胃镜下金属支架置入术治疗上消化道狭窄的临床疗效及安全性。方法对79例上消化道狭窄患者采用内镜直视以及X线监视与内镜直视相结合的方法放置金属支架。结果 79例患者均一次性成功放置金属支架,吞咽困难得到缓解;3例食管气管瘘得到有效封堵。结论放置金属支架是治疗上消化道狭窄安全有效的方法,但也需注意减少、减轻并发症的发生。     

医源性肝外胆管狭窄的修复

目的总结肝外胆管狭窄医源性损伤的修复经验。方法回顾性分析18例医源性胆管狭窄病人的临床资料。结果本组治愈17例,死亡1例,16例获随访,随访时间1～5年,效果良好。结论杜绝胆管损伤是每位普外科医生所必须重视的问题。一旦发生胆管损伤应视损伤程度和范围拟定合理的修复方案,不可草率从事。对于术中发现的胆管损伤做到细致的胆管无张力吻合,无漏胆,及术后长时间的胆管内支撑是预防医源性肝外胆管狭窄的关键。