内镜下狭窄切开术治疗结直肠癌术后吻合口狭窄后早期关闭造口的研究

目的 分析结直肠癌术后吻合口狭窄患者行内镜下切开术后疗效和在短期内关闭临时性造口的手术并发症。方法 回顾性分析2014年1月至2016年12月期间于中山大学附属第六医院行结直肠癌术后发生吻合口狭窄并接受内镜下狭窄切开术的患者临床资料，纳入7例在术后早期（2周内）行临时性造口关闭术的患者，分析内镜下吻合口狭窄切开术的近期及远期效果，以及早期行造口关闭术的手术并发症发生情况。结果 7例患者接受内镜下吻合口狭窄切开术后内镜通过率为100%，所有患者在2周内（6.6±2.9天）行临时性造口关闭术，术后均无吻合口出血、吻合口瘘、腹腔脓肿及肠梗阻等并发症发生。7例患者接受了平均30.2±10.8月的随访，2例患者再次出现吻合口狭窄，内镜狭窄切开术的长期有效率为71.4%。吻合口狭窄复发的2例患者中，1例再次接受了内镜下狭窄切开术，另1例接受了内镜下狭窄切开术和球囊扩张术。结论 结直肠癌术后吻合口狭窄行内镜下狭窄切开术效果良好，切开后早期行临时性造口关闭是安全的。

Study on the early stoma closure after endoscopic stricturotomy in the treatment of postoperative anastomotic stricture of colorectal cancer

Objective To analyze the effect of endoscopic stricturotomy of anastomotic stenosis in patients with colorectal cancer and the complications of short-term closure of temporary stoma. Methods Clinical data of 7 colorectal cancer patients with postoperative anastomotic stricture underwent stoma closure after endoscopic stricturotomy in less than 2 weeks at The Sixth Affiliated Hospital of Sun Yat-sen University between January 2014 and December 2016 were retrospectively collected. The short-term and long-term effects of endoscopic stricturotomy and the incidence of surgical complications were analyzed after stoma closure. Results The endoscopic pass rate of 7 patients after endoscopic stricturotomy was 100%. All the cases underwent stoma closure after endoscopic stricturotomy in less than 2 weeks （6.6±2.9 days）. No complication was recorded after stoma closure. 2 cases accepted endoscopic intervention due to stricture recurrence. The long-term efficient rate was 71.4% with 30.2±10.8 months follow up. Conclusion Endoscopic stricturotomy in the treatment of postoperative anastomotic stricture of colorectal cancer is effective. Stoma closure after stricturotomy with short interval is safe.