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。

Effects of endoscopic balloon dilatation on treatment of benign stenosis of colorectal anastomosis: a retrospective study

ObjectiveTo evaluate the efficacy and safety of endoscopic balloon dilation (EBD) on treatment of benign colorectal anastomotic stenosis. MethodsData of 36 patients with benign colorectal anastomotic stenosis undergoing EBD at Zhongshan Hospital from 2011 to 2015 were reviewed retrospectively. The number of dilation, complications rate, short-term effects and recurrence rate of stenosis were analyzed. ResultsThirty-six patients had post-surgery anastomotic stenosis within 2-49 months (median 6 months), including 10 (27.8%) patients of grade 1 stenosis, 15 (41.7%) of grade 2 stenosis, and 11 (30.5%) of grade 3 stenosis. The anastomotic distance from anus was 3-24 cm (median 6 cm). The 36 patients underwent 80 times of EBD with mean time of 2.22. Among them, 69.4% (25/36) cases received 1-2 times and 30.6% (11/36) received 3 times or more. During the EBD operation, 14 (17.5%) patients had minor bleeding, and intraoperative or postoperative perforation did not appeared. Postoperative obstructive symptoms were relieved in all patients. The anastomotic diameter was greater than 20 mm and EBD treatment was successful. Postoperative follow-up was 22-76 months (median 44 months). Four (11.1%) patients had recurrence of anastomotic benign stenosis at 7, 11, 18, and 63 months after the last time of EBD, respectively, and the symptoms were improved after the second treatment. ConclusionEBD is safe and effective in treating benign colorectal anastomotic stenosis, with better short-term and long-term outcomes.