Paper - WANFANG MED ONLINE

You Position: Home > Paper

Interventional procedure for benign and malignant stricture or obstruction of upper gastrointestinal tract

( views:298, downloads:4 )

Author:: No author available

Journal Title:: WORLD CHINESE JOURNAL OF DIGESTOLOGY

Issue:: 12

DOI:: 10.3969/j.issn.1009-3079.2000.12.009

Key Word:: 上胃肠道;狭窄;介入治疗;方法;中长期;疗效;适应证

Abstract：目的探讨上胃肠道良恶性狭窄或阻塞有效的介入治疗方法和它的优选法及其中远期疗效.方法上胃肠道(upper gastrointestinal tract,UGIT)良恶性狭窄或阻塞患者120例,其中UGIT良性狭窄球囊导管扩张术组(A组)35例;UGIT恶性狭窄或阻塞永久性无膜和带膜或部分带膜金属支架扩张组(B组)35例;UGIT良性狭窄永久性部分带膜金属支架扩张组(C组)25例;UGIT良性狭窄暂时性部分带膜金属支架扩张术组(D组)25例.A组在X线引导下行球囊扩张;B组、C组和D组在X线引导下放置部分带膜和无膜金属支架,D组在支架术后3 d～7 d由内镜取出.所有患者治疗前吞咽困难评分2～4级.结果A组35例共进行67次球囊扩张,平均1.9次.B组35例安放无膜或部分带膜金属支架35只.C组25例安放部分带膜金属支架15只;无膜金属支架10只.D组25例安放部分带膜金属支架25只.B,C和D组支架置入成功率100%;D组支架取出成功率100%.A组UGIT管腔最窄处直径术前为(3.1±1.7)mm,术后为(8.9±3.3)mm;吞咽困难评分术前为(2.7±1.2)级,术后为(1.1±0.4)级;并发症发生率为疼痛29%(10/35)、反流23%(8/35)、出血9%(3/35);超过1 a的随访患者中91%(32/35)复发吞咽困难.B组UGIT管腔最窄处直径术前为(2.9±2.5)mm,术后为(17.3±2.5)mm;吞咽困难评分术前为(3.1±0.5)级,术后为(1.6±0.7)级;并发症发生率为疼痛20%(7/35)、反流9%(3/35)、出血14%(5/35)、支架移位6%(2/35);超过6 mo的随访患者中17%(6/35)复发吞咽困难,超过1 a的随访患者中50%(15/30)复发吞咽困难.C组UGIT管腔最窄处直径术前为(3.1±2.4)mm,术后为(17.7±2.1)mm;吞咽困难评分术前为(2.5±1.1)级,术后为(0.5±0.3)级;并发症发生率为疼痛40%(10/25)、反流60%(15/25)、出血12%(3/25)、支架移位16%(4/25);超过6 mo的随访患者中20%(5/25)复发吞咽困难,超过1 a的随访患者中25%(3/12)复发吞咽困难.D组UGIT管腔最窄处直径术前为(3.3±2.2)mm,术后为(15.1±2.9)mm;吞咽困难评分术前为(2.8±0.9)级,术后为(0.6±0.4)级;并发症发生率为疼痛40%(10/25)、反流12%(3/25)、出血16%(4/25);超过6mo的随访患者中12%(3/25)复发吞咽困难,超过1 a的随访患者中13%(2/15)复发吞咽困难.结论带膜或部分带膜金属支架是UGIT恶性狭窄或阻塞介入治疗首选方法;球囊导管多次分级扩张术和暂时性部分带膜金属支架扩张术是UGIT良性狭窄介入治疗中的有效方法;在UGIT良性狭窄介入治疗中远期疗效方面,暂时性部分带膜金属支架扩张术是首选方法.

Reference

[1]陈维雄,程英升,杨仁杰,等.暂时性金属内支架扩张术介入治疗贲门失弛缓及其中远期疗效分析[J].2000,(8).
[2]Spinelli P.,Cerrai F. G.,Dal Fante M.,etc.Endoscopic Treatment of Upper Gastrointestinal Tract Malignancies[J].1993.
[3]Etienne-Henry Metman,Jean-Paul Lagasse,Louis d’Alteroche,etc.Risk factors for immediate complications after progressive pneumatic dilation for achalasia[J].1999,94(5).
[4]Yoneyama F,Nimura Y,Miyachi M.Manometric findings of the upper esophageal sphincter in esophageal achalasia.[J].1998,22(10).
[5]J, Lisy,M, Hetková,J, Snajdauf,etc.Long-term outcomes of balloon dilation of esophageal strictures in children.[J].1998,5(12).
[6]M F Vaezi,J E Richter,C M Wilcox,etc.Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial[J].1999,44(2).
[7]Michael F Vaezi,Mark E Baker,Joel E Richter.Assessment of esophageal emptying post-pneumatic dilation: use of the timed barium esophagram[J].1999,94(7).
[8]Beckingham IJ,Bornman PC,Louw JA,etc.Laparoscopic cardiomyotomy for achalasia after failed balloon dilatation.[J].1999,13(5).
[9]Ell C.,May A..Self-Expanding Metal Stents for Palliation of Stenosing Tumors of the Esophagus and Cardia: A Critical Review[J].1997.
[10]Ell C,Schneider TH,Muehldorfer SM,etc.Esophageal achalasia: intrasphincteric injection of botulinum toxin A versus balloon dilation.[J].1999,31(7).
[11]M, Gaudric,J M, Sabate,P, Artru,etc.Results of pneumatic dilatation in patients with dysphagia after antireflux surgery.[J].1999,86(8).
[12]P O, Katz,J, Gilbert,D O, Castell.Pneumatic dilatation is effective long-term treatment for achalasia.[J].1998,43(9).
[13]C F, Torbey,E, Achkar,T W, Rice,etc.Long-term outcome of achalasia treatment: the need for closer follow-up.[J].1999,28.
[14]卢清鑫,张志强,王建军,等.自制贲门扩张器治疗贲门失弛症（附110例报告）[J].1994,(3).
[15]W Cwikiel,R Willén,H Stridbeck,etc.Self-expanding stent in the treatment of benign esophageal strictures: experimental study in pigs and presentation of clinical cases.[J].1993,187(3).
[16]Anwaar A Khan,S.Waqar H Shah,Altaf Alam,etc.Pneumatic balloon dilation in achalasia: a prospective comparison of balloon distention time[J].1998,93(7).
[17]Seelig M. H.,DeVault K. R.,Seelig S. K.,etc.Treatment of Achalasia[J].1999.
[18]P. Alonso,B. Gonzalez-Conde,R. Macenlle,etc.Achalasia (The Usefulness of Manometry for Evaluation of Treatment)[J].1999,44(3).
[19]Vaezi MF.Achalasia: diagnosis and management.[J].1999,10(3).
[20]Kozarek R. A..Esophageal Stenting - When Should Metal Replace Plastic?[J].1998.
[21]V, Singh,A, Duseja,A, Kumar,etc.Balloon dilatation in achalasia cardia.[J].1900,20(2).
[22]C, Prakash,K E, Freedland,M F, Chan,etc.Botulinum toxin injections for achalasia symptoms can approximate the short term efficacy of a single pneumatic dilation: a survival analysis approach.[J].1999,94(2).
[23]Morgan DE,Yates-MR 3rd,Baron TH.Palliation of malignant gastric and small intestinal strictures with self-expandable metal stents.[J].1998,30(3).
[24]A A, Khan,S W, Shah,A, Alam,etc.Massively dilated esophagus in achalasia: response to pneumatic balloon dilation.[J].1999,94(9).
[25]S C, Kadakia,R K, Wong.Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia.[J].1993,88.
[26]I T, Pinto.Malignant gastric and duodenal stenosis: palliation by peroral implantation of a self-expanding metallic stent.[J].1900,20(6).
[27]R, Panaccione,J C, Gregor,R P, Reynolds,etc.Intrasphincteric botulinum toxin versus pneumatic dilatation for achalasia: a cost minimization analysis.[J].1999,50(4).
[28]S, Horgan,C A, Pellegrini.Botulinum toxin injections for achalasia symptoms.[J].1999,94.
[29]Vaezi MF,Richter JE.Current therapies for achalasia: comparison and efficacy.[J].1998,27(1).
[30]Strecker EP,Boos I,Husfeldt KJ.Malignant duodenal stenosis: palliation with peroral implantation of a self-expanding nitinol stent.[J].1995,196(2).
[31]Catanzano C,De-Palma GD.Removable self-expanding metal stents: a pilot study for treatment of achalasia of the esophagus.[J].1998,30(8).
[32]Koehler RE,Baron TH,Mauro MA.Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents.[J].2000,215(3).
[33]R R, Saxon,R E, Barton,R M, Katon,etc.Treatment of malignant esophageal obstructions with covered metallic Z stents: long-term results in 52 patients.[J].1900,6.
[34]R M, Gideon,D O, Castell,J, Yarze.Prospective randomized comparison of pneumatic dilatation technique in patients with idiopathic achalasia.[J].1999,44(9).