食管癌术后难治性吻合口狭窄的内镜治疗  

Endoscopic management of recurrent anastomotic stenosis after surgery of esophageal carcinoma

作　　者：葛相栓[1] 王慧超[1] 李建平[1] 刘小玲[1] 张顺风[1] 钱峰[1] GE Xiangshuan;WANG Huichao;LI Jianping;LIU Xiaoling;ZHANG Shunfeng;QIAN Feng(Department of gastroenterology,Henan Honliv Hospital,Changyuan,Henan 453400,China)

机构地区：[1]河南宏力医院消化内科,河南长垣453400

出　　处：《安徽医药》2018年第8期1517-1520,1644,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨内镜下不同治疗方法在食管癌术后难治性吻合口狭窄中的作用。方法对2006年12月至2014年6月就诊的36例经内镜治疗的食管癌术后难治性吻合口狭窄患者的临床资料进行回顾性分析,比较单纯扩张、扩张+支架及扩张+放射粒子对术后难治性吻合口狭窄的治疗效果,分析不同部位、不同性质狭窄的最佳治疗方法。结果 36例患者中7例单纯反复内镜下扩张治疗;5例扩张后置放营养管,其中2例后续放射治疗;18例扩张后置放1枚食管支架,其中1例后续放射治疗;3例扩张后置放2枚支架,2例扩张后置放1枚附有放射粒子的支架;1例扩张后放置3枚支架。治疗过程中及治疗后出现的胸骨后疼痛、恶心、胸部闷胀不适等症状经对症处理后均消失,无穿孔、大出血等严重并发症发生。随访6个月治愈29例,有效5例,无效2例。结论内镜治疗在食管癌术后难治性吻合口狭窄中具有重要作用,针对不同的狭窄原因可以采取不同的治疗措施。Objective To evaluate the different endoscopic management for the treatment of recurrent anastomotic stenosis after surgery of esophageal carcinoma. Methods The clinical data of 36 patients with recurrent anastomotic stenosis after surgery of esophageal carcinoma from December 2006 to June 2014 were analyzed retrospectively. Results Esophageal dilation was performed for seven patients with anastomotic stenosis after Surgery of Esophageal Carcinoma repeatedly. Five paients were put nutrient canal after esophageal dilation,and two of them had followed a radiotherapy. Eighteen cases are placed one stent after esophageal dilation,and six of them have followed radiotherapy. Three cases were placed two stents successively. Two cases were placed one stent with radioactive particle.One case was placed three stents. All the patients were scheduled a follow-up visit in six months,twenty-nine patients were cured,five cases were effective,two cases were ineffective. Conclusion Endoscopic Management plays an important role in treatment of recurrent anastomotic stenosis after surgery of esophageal carcinoma and different measures can be choosed according to the different cause of stenosis.

关 键 词：内镜 治疗 吻合口狭窄 食管癌切除术 

分 类 号：R735.1[医药卫生—肿瘤]