单气囊小肠镜下球囊扩张术治疗克罗恩病伴小肠狭窄初步临床研究  

Endoscopic balloon dilatation of small bowel stricture in Crohn＇s disease with single balloon enteroscopy

作　　者：杜奕奇[1] 王小璇[1] 陈洁[1] 徐灿[1] 苏暾[1] 席惠君[1] 姚银珍[1] 吴仁培[1] 李兆申[1] 

机构地区：[1]上海长海医院消化科,200433

出　　处：《中华消化杂志》2012年第6期379-383,共5页Chinese Journal of Digestion

摘　　要：目的初步探讨单气囊小肠镜辅助下球囊扩张术治疗克罗恩病伴小肠狭窄的有效性和安全性。方法7例克罗恩病患者共行10次扩张术，男性4例，女性3例，平均年龄（37．6±13．5）岁。术前均经影像及病理检查确诊克罗恩病伴不同程度肠梗阻，共有8处严重狭窄，6处位于空肠。扩张术采用控制性径向球囊扩张器（CRE）球囊进行逐级扩张，以扩张后内镜可进入远端肠腔为标准。结果球囊扩张术成功率达8／10，小肠狭窄平均直径由治疗前的（4．1±2．5）mm扩张至（10．2±1．5）mm（t=-8．111，P〈0．01），可进镜深度平均达62cm，2例患者分别扩张2次及3次。所有患者术后腹痛及肠梗阻症状明显缓解，均未出现出血及穿孔等严重并发症。术后平均随访14个月，2例行手术治疗，另2例因症状复发再次行扩张治疗，中位无症状时间为15个月，70％的患者1年内无症状复发。结论依托于单气囊小肠镜的小肠狭窄扩张术是一项内镜治疗新技术，可安全、有效地治疗克罗恩病并发的肠梗阻。Objective To explore the efficacy and safety of endoscopic balloon dilatation of small bowel stricture in Crohnrs disease with single balloon enteroscopy （SBE）. Methods Seven Crohnrs disease patients （four males and three females with a mean age of 37 years） were underwent 10 times dilatation. Before performance, Crohn＇s disease with varying degrees of intestinal obstruction was confirmed by image and pathological examinations. There were 8 severe strictures, 6 strictures in jejunum. The dilatation was performed step by step with controlled radial expansiondilator （CRE） balloon. After dilatation, the scope could reach the further small bowel was taken as a standard. Results The overall success rate was 8 of 10. The average diameter of intestinal stricture was expanded from （4. 1±2.5） mm before therapy to （10.2±1. 5） mm （P〈0.01）, and the average distance of the further small bowel that the scope reached was 62 cm. Two patients underwent twice and three times of dilatation. After the performance, all patientsr symptoms of abdominal pain and obstruction relieved obviously and there were no severe complication of bleeding or perforation. After the performance, the average follow-up time was 14 months, two patients were treated by surgery and the other two underwent dilatation treatment again because of the recurrence of symptoms. The median symptom-free time was 15 months and 70% of patients were without symptom recurrence in one year. Conclusion Endoscopic balloon dilatation of small bowel stricture with SBE is a new technology of endoscopic treatment, which is safe and effective in the treatment of Crohn＇s disease complicated with intestinal obstruction.

关 键 词：内窥镜检查 胃肠道 小肠 气囊扩张术 克罗恩病 缩窄 病理性 

分 类 号：R656.9[医药卫生—外科学]