内镜下扩张及内支架置入治疗食管贲门吻合口狭窄

    Treatment of esophageal cardiac and anastomotic mouth stricture by dilation and implantation of stents under endoscopy

    • 摘要: 目的: 探讨内镜下扩张及内支架置入治疗食管贲门吻合口狭窄的方法、疗效及安全性。方法: 33例食管贲门吻合口狭窄患者,在内镜及X线透视下,插入导丝并越过狭窄段,以沙氏探条扩张器由细至粗渐扩至10~15 mm。恶性狭窄与食管贲门癌术后瘢痕狭窄或术后复发患者,在扩张结束后行内支架置入治疗。结果: 33例中18例行扩张治疗,扩张1~2次者17例,1例扩张4次;15例行扩张和内支架置入治疗,均1次扩张与置管成功。术后狭窄程度按Stooler分级下降Ⅱ级者28例,Ⅰ级者4例,未下降者1例。术中、术后无剧烈疼痛、大出血、穿孔等并发症。结论: 内镜下扩张及内支架置入治疗食管贲门及吻合口狭窄近期疗效良好,安全性较高。治疗成功的前提是导丝通过狭窄段,保证是固定好导丝,关键是狭窄段的有效扩张与支架置放位置的准确。

       

      Abstract: Objective: To study the procedure,effect and safety of treating esophageal cardiac and anastomotic mouth stricture by dilation and implantation of stents under endoscopy.Methods: Thirty-three cases of esophageal cardiac and anastomotic mouth stricture were treated by inserting a lead through the stricture part under endoscopy and X-ray fluoroscopy,then a Savary-Gilliard dilator was used to dilate the stricture part slowly to 10-15 mm.For those who had malignant stricture,post-operative stricture or recurrence of carcinoma,stents were implanted in addition to ditation.Results: Eighteen cases were treated by dilation only,17 of whom received the therapy for one or two times;and 1 of whom four times;15 cases were treated by dilation,as well as implantation of stents.All were successful for once.After operation,the stricture state decreased Ⅱ degreses by Stooler standard in 28 cases,I degree in 4 cases and did not decrease in 1 case.No severe pain,massive haemoorrhage or perfortion occurred.Conclusions: It is effective and safe to treat esophageal cardiac and anastomotic mouth stricture by dilation and implatation of stents under endoscopy.In the operation,we must make sure that the lead goes through the stricture part and is properly fastened;the stricture part is expanded effectively and the stent implanted in place.

       

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