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内镜下放射状切开术和切割方法治疗难治性食管胃吻合口狭窄的实用性

发布日期:2014-1-29 12:40:38 文章来源:GIE 作者次数:1244

     内镜下放射状切开术和切割方法治疗难治性食管胃吻合口狭窄的实用性

    背景

    对多次内镜下球囊扩张术(EBD)难以治疗的胃吻合口狭窄,目前没有有效的治疗方法。然而,世界各地的人们仍会选择EBD治疗这些难治性狭窄。因此为缓解吞咽困难症状和保持管腔张开,我们开发了一项新的切开治疗法,即放射状切开术和切割RIC)。

    目的

    评估RIC法治疗难治性吻合口狭窄的有效性和安全性。

    设计

    回顾性队列研究。

    环境

    国立癌症中心和大学医院。

    患者

    本研究纳入54例难以采用食管胃手术治疗吻合口狭窄的患者。

    干预

    放射状切开术和切割

    主要测量指标

    与持续使用内镜下球囊扩张术相比,采用RIC的安全性和临床成功率,以及RIC治疗后的长期通畅率。

    结果

    RIC手术中位时间为14分钟(范围:4-40分钟)。未观察到任何与RIC相关的严重不良事件。RIC后,81.3%的患者即刻能够吃下固体食物,且没有吞咽困难的症状。作为一种短期疗效,RIC后,93.8%30/32)的患者吞咽困难症状有所改善。同时作为一种长期疗效,RIC术后6月与12月,分别有63%17/27)和

    62%13/21)的患者可吃下固体食物。在采用RIC与持续采用EBD两组之间,6月和12月的通畅率显著不同,分别为65.3% 19.8%P < 0.005,及61.5% 19.8%P <0 .005

    局限性

    非随机回顾性研究。

    结论

    RIC安全有效。对于采用手术切除治疗胃食管疾病遗留下的难治性狭窄患者,该方法的有效性证明RIC可作为一种新的有效治疗该狭窄的医疗手段。

    缩写词EBD,内镜下球囊扩张术;IT,绝缘端;RIC,放射状切开术和切割。

     


    Usefulness of endoscopic radial incision and cutting method for refractory esophagogastric anastomotic stricture

    Background

    There is no effective treatment for gastroesophageal anastomotic strictures that are refractory to repeated endoscopic balloon dilation (EBD). However, EBD is still selected worldwide to manage such refractory strictures. To relieve the symptoms of dysphagia and keep a wide lumen, we developed a new incisional treatment, radial incision and cutting (RIC).

    Objective

    To evaluate the efficacy and safety of the RIC method for the treatment of refractory anastomotic strictures.

    Design

    Retrospective cohort study.

    Setting

    National CancerCenterand University Hospital.

    Patients

    This study involved 54 consecutive patients with refractory anastomotic stricture after esophagogastric surgery.

    Intervention

    RIC.

    Main Outcome Measurements

    The safety and clinical success of RIC and the long-term patency after RIC compared with those of continued EBD.

    Results

    The median procedure time of RIC was 14 minutes (range, 4–40 minutes). No serious adverse events associated with RIC were observed. Immediately after RIC, 81.3% (26/32) of patients were able to eat solid food without symptoms of dysphagia. As a short-term effect, the dysphagia improved after RIC in 93.8% (30/32) of the patients. As a long-term effect, 63% (17/27) and 62% (13/21) of patients were able to eat solid food 6 and 12 months after RIC, respectively. The 6-month and 12-month patency rates were significantly different between the RIC group and the continued EBD group (65.3% vs 19.8%, P < .005; 61.5% vs 19.8%, P < .005).

    Limitations

    Nonrandomized retrospective study.

    Conclusions

    RIC is an effective and safe method. The demonstration of the validity of this method may place RIC as a new medical treatment for patients with refractory stricture after surgical resection for esophagogastric diseases.

    Abbreviations:  EBD, endoscopic balloon dilation, IT, insulated tip, RIC, radial incision and cutting

     

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