内镜介入治疗食管狭窄

目的 探讨内镜介入治疗食管贲门狭窄的方法、疗效及不良反应，寻求较为合理的治疗组合。方法 223例癌性狭窄病人，随机分为内镜下注射化疗药物、微波凝固、注射加微波加温、食管内支架治疗，35例放、化疗为对照组。118例良性狭窄，分别用高频电切、微波凝固、支架治疗。观察梗阻缓解情况、平均生存期、转移灶情况、并发症及不良反应。结果 梗阻缓解情况，恶性狭窄组总有效率为91．03％，单纯化疗组为55％，单纯放疗组为87％。良性狭窄组分别为77．4％、98．8％和100％。平均生存期，恶性组为11．75个月，对照组分别为8．3、13．8个月。良性组分别为39、42、44个月。结论 内镜介入治疗食管贲门癌性狭窄缓解梗阻优于放疗和化疗。病人生存期长于化疗，而与放疗接近，各治疗方法中以支架加化疗最佳。良性狭窄以消融扩张为首选，对反复狭窄再考虑用内支架。

Endoscopic Interventional Treatment of Esophageal and Cardiac Stricture

Objective To evaluate the endoscopic interventional treatment of esophageal and cardiac tricture,and search for more reasonable and effective treatment measures.Methods The 223 patients with malignant esophageal and cardiac trictures were randomly divided in treatment with endoscopic chemotherapy,microwave thermocoagulation,combination of chemotherapy and microwave thermocoagulation,and stent implantation.The 118 patients with benign strictures were randomly divided in treatment with hyperfrequency electroincision,microwave thermocoagulation and stent implantation.Systemic chemotherapy and radiotherapy were given to 35 patients in control group.Results The malignant dysphagia was palliated in 91.03 % for endoscopic interventional treatment,while 55 %or 87 % for radiotherapy or chemotherapy in control group.The average survival period in malignant esophageal and cardiac strictures was about 11.8 months,while it was about 40 months in the benign strictures.Conclusion Endoscopic interventional treatment is all effective therapy for malignant and benign esophageal and cardiac strictures,its effect is superior over chemotherapy and radiotherapy.The survival period is longer than that in chemotherapy and approximately equal to radiotherapy.The combination of stent and chemotherapy is the best one among the different therapeutic measure.The first choice therapy is ablation enlargement in treating benign stricture,but the stent should be considered in recurrent strictures.