内镜下扩张治疗食管和贲门良性狭窄438例临床分析  

Clinical analysis of 438 cases of endoscopic dilatation for benign esophageal and cardiac stricture

作　　者：高飞[1] 张迎春[1] 艾美娜[1] 麻树人[1] 张宁[1] 王冰[2] 杨林[1] 

机构地区：[1]沈阳军区总医院内窥镜科,辽宁沈阳110840 [2]沈阳军区总医院医务部,辽宁沈阳110840

出　　处：《上海医学》2014年第6期507-510,共4页Shanghai Medical Journal

摘　　要：目的评价内镜下扩张治疗食管和贲门良性狭窄的临床疗效。方法对2006年1月—2011年1月沈阳军区总医院内窥镜科收治的食管或贲门良性狭窄患者的临床资料进行回顾性分析,狭窄原因为瘢痕性食管狭窄、食管癌或贲门癌术后吻合口狭窄和贲门失弛缓症。记录所有患者吞咽困难程度、扩张方法和扩张次数,分析经内镜不同的扩张方法治疗中的扩张次数,并评价其疗效。结果 438例患者中,瘢痕性食管狭窄77例,食管或贲门癌术后吻合口狭窄257例,贲门失弛缓症104例;经内镜下扩张治疗后,食管癌或贲门癌术后吻合口狭窄和贲门失驰缓症患者的疗效满意率分别为96.9%(249/257)和96.2%(100/104),均显著高于瘢痕性食管狭窄患者的70.1%(54/77,P值均<0.05)。内镜下扩张治疗瘢痕性食管狭窄过程中,探条和单球囊扩张次数≤5次的构成比分别为40.5%(15/37)和43.8%(14/32),均显著低于双球囊扩张次数≤5次的7/8(P值均<0.05);内镜下扩张治疗食管癌或贲门癌术后吻合口狭窄过程中,探条和联合扩张次数≤5次的构成比分别为8/20和5/18,均显著低于单球囊和双球囊扩张次数≤5次的80.8%(135/167)和100.0%(52/52,P值均<0.05);内镜下扩张治疗贲门失弛缓症过程中,单球囊扩张次数≤3次的构成比为27.8%(15/54),显著低于双球囊扩张次数≤3次的64.0%(32/50,P<0.05)。结论内镜下扩张治疗食管狭窄时根据食管狭窄的不同病因,选择合适的扩张方法可减少扩张次数,并可获得较满意的疗效。Objective To investigate the clinical outcomes of endoscopic dilatation for treatment of benign esophageal and cardiac stricture. Methods Clinical data of patients with benign esophageal and cardia stricture dilated under endoscope in our hospital between January 2006 and January 2011 were retrospectively analyzed. The causes of stricture included cicatricial oesophageal stricture, anastomotic stoma stricture after surgical treatment for esophageal carcinoma or carcinoma of gastric cardia, and achalasia of cardia. The level of dysphagia and the method and times of dilatation were recorded. Results Among 438 cases, there were 77 cases of cicatricial oesophageal stricture, 257 cases of postoperative stenosis of esophageal and cardia cancer, and 104 cases of cardiac achalasia. The effective rate of endoscopic dilation for postoperative stenosis （96.9 %, 249/257） and cardiac achalasia （96.2%, 100/104） was significantly higher than that of cicatricial oesophageal stricture after treatment （70. 1%, 54/77, both P 〈 0. 05）. Among cases of cicatricial oesophageal stricture treated by endoscopic dilation, proportion of patients in whom bougienage （40.5%, 15/37） and single-balloon dilatation （43.8 %, 4/32） were less than 5 times was lower than that of double-balloon dilatation （7/8, both P〈0.05）. Among cases of postoperative stenosis, proportion of patients in whom bougienage （8/20） and combined dilatation （5/18） were less than 5 times was lower than that of single-balloon dilatation （80.8%, 135/167） and double-balloon dilatation （100.0%, 52/52, all P〈0.05）. Among cases of cardiac achalasia, proportion of patients in whom double-balloon dilatation （64.0%, 32/50） was less than 3 times was significantly higher than that of single-balloon dilatation （27.8%, 15/54, P〈0.05）. Conclusion Endoscopic dilatation for benign esophageal and cardiac stenosis is effective. Double-balloon dilatation can reduce times of dilatation for cicatricial esophageal stenosis and esophageal acha

关 键 词：食管 良性狭窄 贲门失弛缓症 内镜 扩张 

分 类 号：R571[医药卫生—消化系统]