数字减影血管造影引导下梯度逐级球囊扩张治疗食管癌术后吻合口狭窄的临床研究  

DSA-guided graded balloon dilatation in the treatment of anastomotic stenosis after esophagectomy

作　　者：杨东强[1] 李亚洲[1] 杨光[1] 时萍 YANG Dongqiang;LI Yazhou;YANG Guang;SHI Ping(Department of Radiology,the 4th Hospital of Hebei Medical University,Shijiazhuang 050011,China;不详)

机构地区：[1]河北医科大学第四医院放射科,石家庄050011 [2]河北医科大学第四医院耳鼻喉科,石家庄050011

出　　处：《实用医学杂志》2022年第17期2185-2190,共6页The Journal of Practical Medicine

基　　金：河北省医学科学研究课题计划(编号:20220151)。

摘　　要：目的 探讨数字减影血管造影(digital subtraction angiography,DSA)引导下梯度逐级球囊扩张治疗食管癌术后吻合口狭窄的临床效果,总结提升扩张效果的方法及经验。方法 回顾性分析我院2015年2月至2020年5月期间,69例食管癌术后吻合口狭窄在DSA引导下行梯度逐级球囊扩张治疗患者的临床资料,依据扩张前后吻合口的大小,评估吞咽困难分级及生存质量评分。结果 DSA引导下梯度逐级球囊扩张能有效改善食管癌术后吻合口狭窄患者的吞咽困难症状;患者手术方式与吻合口扩张效果无统计学意义(P> 0.05);球囊扩张与食管癌手术间隔12周以内的扩张效果优于间隔12周以上的(P <0.05);前两次球囊扩张时间间隔2周以内的效果好于间隔2周以上(P <0.05);扩张2次以上的患者的生存质量评分高于仅扩张2次的(P <0.05)。结论 对于食管癌术后吻合口狭窄,DSA引导下的梯度逐级球囊扩张治疗优势明显,术中可通过梯度压力法进行渐进性扩张,选择最合适的扩张终点,手术后12周以内进行球囊扩张和间隔2周以内进行第二次球囊扩张均可提高吻合口的扩张效果,适当增加扩张的次数,可提高患者的生存质量评分。Objective To investigate the clinical effect of gradient step-by-step balloon dilatation guidedby digital subtraction angiography(DSA)for anastomotic stricture after esophageal cancer surgery. Methods Theclinical data of 69 patients with anastomotic stricture after esophageal cancer surgery who underwent DSA guidedgradient step-by-step balloon dilatation from February 2015 to May 2020 in our hospital were retrospectivelyanalyzed. According to the size of anastomotic stoma before and after dilatation,dysphagia grade and quality of lifescore were assessed. Results DSA guided gradient step-by-step balloon dilatation effectively improved dysphagiasymptoms in patients with anastomotic stricture after esophageal cancer surgery. No statistical significance wasfound in surgical methods and anastomotic dilatation effect(P > 0.05);the dilatation effect of balloon dilatationand esophageal cancer surgery within 12 weeks was better than that within 12 weeks(P < 0.05);the effect of thefirst two balloon dilatation time within 2 weeks was better than that at more than 2 weeks(P < 0.05);the quality oflife score of patients with more than two dilations was higher than that of patients with only two dilations(P < 0.05).Conclusion For anastomotic stricture after esophageal cancer surgery,DSA guided gradient step-by-step balloondilatation had obvious advantages. Progressive dilatation could be performed by gradient pressure method duringoperation. The most appropriate dilatation endpoint could be selected. Balloon dilatation within 12 weeks afteroperation and the second balloon dilatation within 2 weeks after interval improved the dilatation effect of anastomoticstoma. Appropriate increase of dilatation times could improve the quality of life score of patients.

关 键 词：数字减影血管造影 球囊扩张术 食管癌 术后吻合口狭窄 

分 类 号：R735.1[医药卫生—肿瘤]