上消化道吻合口狭窄原因及内镜球囊扩张疗效分析

目的　探讨上消化道吻合口狭窄内镜球囊扩张治疗的近、远期疗效及其影响疗效的因素 ,分析引起吻合口狭窄的原因。方法　应用内镜球囊扩张术治疗食管癌、胃癌切除术引起的吻合口狭窄 1 94例 ,术后用内镜、钡餐造影定期随访并观察梗阻症状、生活质量及生存期等。结果　经内镜下球囊扩张治疗后吻合口狭窄的近期症状缓解率为 96 4 % (1 87/ 1 94 )。治疗后吻合口平均直径由0 4 4cm增加到 2 36cm(P <0 0 0 1 )。该方法的主要并发症为黑便 (2 1 % )和穿孔 (1 0 % )。治疗后随访 0 5、1、2和 3年梗阻症状缓解率依次为 88 1 %、92 7%、91 6 %和 90 1 % ;生存率分别为98 4 %、89 8%、2 5 8%和 2 2 3%。绝大多数患者死于肿瘤复发和转移 (92 6 % ) ,极少数死于反复狭窄 (2 1 % )。该方法的疗效与狭窄部位、狭窄程度、球囊扩张参数有关。吻合口狭窄的发生可能与吻合口部位 (如食管上段、食管 胃吻合口狭窄 )、吻合口留置过小、双合钉使用不当、放射治疗等有关。结论　应用内镜下球囊扩张治疗上消化道吻合口狭窄安全可靠 ,近期和远期均有很高的疗效。

Balloon dilation of anastomotic stenosis in upper gastrointestinal tract and analysis of its causes

Objective To evaluate the efficacy of anastomotic stenosis in upper gastrointestinal tract treated by balloon dilation under endoscopies and to analyze the causes of stenosis.Methods Balloon dilation under endoscopies was performed in 194 patients with anastomotic stenosis who had undergone esophagectomy or gastrectomy due to their malignancies. All patients were followed up for their symptoms, life quality and surviving times, and were regularly examined by endoscopies and esophageal barium radiography.Results The dysphagia in short term was completely released in 96 4% (187 of 194 patients). The average diameter of stoma was extended significantly from 0 44 cm to 2 36 cm after the therapy ( P <0 001). The main complications of the balloon dilation are melena (2 1%) and perforation (1 0%). After follow up in 6 months, 1 year, 2 years and 3 years, the remission rates of obstruction were 88 1%, 92 7%, 91 6% and 90 1% respectively; the related surviving rates were 98 4%, 89 8%, 25 8% and 22 3% respectively. Most patients were died of the relapse and metastasis of the original malignancies (92 6%). Rarely, they died of the repeated stenosis (2 1%). The efficacy was affected by the location of stoma, the primary diameter of stenosis and the parameters used in dilation The formation of anastomotic stenosis might be related to the location of stoma (upper segment of esophagus, stenosis of esophagogastric anastomosis), the insufficient diameter of primary stoma, the unsuitable use of double close nails and irradiation therapy.Conclusion Balloon dilation under endoscopies for patients with anastomotic stenosis in upper gastrointestinal tract is a safe and reliable approach and it has a promising effect in long term as well as in short term follow up.