上胃肠道良性狭窄的介入治疗随访研究和评价

目的 对上胃肠道良性狭窄介入治疗进行随访和评价。方法 85例上胃肠道（upper gastrointestinal tract,UGIT)良性狭窄患者,其中球囊导管扩张术组（A组）35例;永久性金属支架扩张组（B组）25例;暂性部分带膜金属支架扩张术组（C组）25例。在X线引导下,A组35例共进行67次球囊扩张,平均1．9次;B组25例安放部分带膜金属支架15只,不带膜金属支架10只;C组25例安放部分带膜金属支架25只,在支架术后3－7d由胃镜取出。治疗前UGIT管腔最窄处直径0．7－8．5mm,吞咽困难评分2－4级;治疗后UGIT管腔最窄处直径5．1－20．0mm,吞咽困难评分0－1级。所有患者术后随访6－36个月（平均19．1个月）。结果 A组术后并发症发生率为疼痛29％（10／35）、返流23％（8／35）、出血9％（3／35）;超过6个月的随访患者中20％（7／35）复发吞困难,超过1年的随访患者中91％（32／35）复发吞咽困难,超过3年的随访患者中95％（19／20）复发吞咽困难。B组术后并发症发生率为疼痛40％（10／25）、返流60％（15／25）、出血12％（3／25）、支架移位16％（4／25）;超过6个月的随访患者中60％（3／5）复发吞咽困难。C组术后并发症发生率为疼痛40％（10／25）、返流12％（3／25）、出血16％（4／25）;超过6个月的随访患者中12％（3／25）复发吞咽困难,超过1年的随访患者中13．3％（2／15）复发吞咽困难,超过3年的随访患者中12．5％（1／8）复发吞咽困难。结论 球囊导管多次分级扩张术和暂时性部分带膜金属支架扩张术是UGIT良性狭窄介入治疗近期疗效中的有效方法;暂时性部分带膜金属支架扩张术是UGIT良性狭窄介入治疗中远期疗效中的首选方法。

Follow-up study and evaluation of benign stricture of upper gastrointestinal tract with interventionalpraccdure

Objective To make follow-up s tudy and e valuation of benign stricture of upper gastrointestinal tract (UGIT) with interv entional procedure. Methods There were 85 cases of benign stric ture of UGIT with interventional procedu re. There were 35 cases with pneumatic dilation (group A), 25 cases with permane nt (group B) placement, and 25 cases with temporary (group C) placement of expan dable metallic stent, respectively. All cases were completed under fluoroscopy. 35 cases of group A had 67 times dilations (mean 1.9 times). Fifteen partial co vered and 10 uncovered expandable metallic stents were permanently placed in the 25 ca ses of group B. 25 partial covered expandable metallic stents were temporari ly p laced in the 25 cases of group C, and the stents were drawn out via gastroscopy 3-7 days later. All stents placement and drawing were technically successful. T he most strictured diameters of UGIT were 0.7-8.5 mm before dilations and 5.1- 200 mm after dilations. Dysphagia scores of all cases were from grade 2 to 4 b efo re dilations, and from grade 0 to 1 after dilations. Follow-up time of all case s was from 6 months to 36 months (mean 19.1 months). Results Complications in group A included chest pain (n=10), reflux (n=8), and bleeding (n =3). Seven (20%) in 35 cases of group A had dysphagia relapse during follow-up over 6 months; 32 (91%) in 35 cases of group A had dysphagia relapse during follow-up over 12 mon t hs; 19(95%) in 20 cases of group A had dysphagia relapse during follow-up over 36 months. Complications in group B included chest pain (n=10), reflux (n =15), bleeding (n=3), and stent migration (n=4). Five (20%) in 25 case s of group B had dysp hagia relapse during follow-up over 6 months; 3(25%) in 12 cases of group B had dysphagia relapse during follow-up over 12 months; 3(60%) in 5 cases of gro up B had dysphagia relapse during follow-up over 36 months. Complications in group C included chest pain (n=10), reflux (n=3), and bleeding (n=4). 3( 12%) in 25 cases of group C had dysphagia relapse during follow-up over 6 months, 2(13.3%) in 1 5 cases of group C had dysphagia relapse during follow-up over 12 months; 1(12.5 % ) in 8 cases of group C had dysphagia relapse during follow-up over 36 months. ConclusionThe effective treatment method of benign stricture of UGIT with inte rventional procedure in short-term therapeutic efficiency were graded pneumatic dilation and temporary placement of partial covered expandable metallic stent. T emporary placement of partial covered expandable metallic stent was the first me thod of choice in the treatment of benign stricture of UGIT in terms of mid and long-term therapeutic efficiency.