摘要
目的 探讨食管恶性肿瘤根治术后吻合口轻中度良性狭窄首次扩张的最佳直径。方法 回顾性分析2015年1月-2022年6月我院83例行食管恶性肿瘤根治术后吻合口良性狭窄患者的临床资料,根据首次内镜下球囊扩张直径分为12 mm组(n=21)、13.5 mm组(n=22)和16 mm组(n=40)。比较3组治疗的安全性、有效性及预后。结果 12、13.5和16 mm组扩张成功率分别为81.0%、90.9%和92.5%、并发症发生率分别为4.8%、4.5%和5.0%,差异均无统计学意义(均P>0.05)。12、13.5和16 mm组1年再狭窄率分别为94.1%、95.0%和67.6%,16 mm组与12 mm组以及13.5 mm组相比,其12个月再狭窄率显著下降(P=0.034,P=0.019)。12 mm组的中位狭窄复发时间为2(1.00, 3.00)月,13.5 mm组的中位狭窄复发时间为3.5(1.00, 5.25)月,16 mm组的中位狭窄复发时间为6.5(1.50, 12.00)月,16 mm组患者较12 mm组及13.5m m组患者狭窄复发时间明显缩短(均P<0.05);12、13.5和16 mm组扩张后1年中位再扩张次数分别为3(2.00, 4.00)、2 (1.75, 3.25)和2(0.00, 2.00)次,16 mm组较12 mm组和13.5 mm组扩张次数明显减少(均P<0.05);12 mm组与13.5 mm组1年再狭窄、狭窄复发时间、1年内再扩张次数相比差异均无统计学意义(P> 0.05)。扩张前直径<5 mm、首次扩张后吻合口直径<15 mm、首次扩张距离手术时间≥3个月,是扩张后1年内再狭窄的危险因素(OR>1,P<0.05)。结论 对于食管恶性肿瘤根治术后吻合口轻中度良性狭窄,首次内镜下扩张至16 mm为最佳扩张直径。
Objective To explore the optimal diameter for the first dilation of mild to moderate benign stenosis of the anastomotic site after radical resection of esophageal malignant tumors.Methods A retrospective analysis was conducted on the clinical data of 83 patients with benign anastomotic stenosis after radical resection of esophageal malignant tumors from January 2015 to June 2022.According to the diameter of the first endoscopic balloon dilation,they were divided into 12mm,13.5mm,and 16mm groups.The safety,effectiveness,and prognosis of the three treatment groups were compared.Results The success rates of expansion in the three groups were 81.0%,90.9%,and 92.5%,respectively,and the incidence of complications was 4.8%,4.5%,and 5.0%,respectively,with no statistically significant difference(P=0.369;P=0.999).The 12 month restenosis rates were 94.1%,95.0%,and 67.6%,respectively.Compared with the 12mm and 13.5mm groups,the 16mm group had a significant decrease in the 12 month restenosis rate(P=0.034,P=0.019).The median recurrence time of stenosis in the 12mm group was 2(1.00,3.00)months,the median recurrence time of stenosis in the 13.5mm group was 3.5(1.00,5.25)months,and the median recurrence time of stenosis in the 16mm group was 6.5(1.50,12.00)months.The recurrence time of stenosis in the 16mm group was significantly shorter than that in the 12mm and 13.5mm groups(P=0.026,P=0.048),and the median number of redilations in the three groups after dilation was 3(2.00,4.00),2(1.75,3.25),and 2(0.00,2.00)times,respectively.The expansion frequency of the 16mm group was significantly reduced compared to the 12mm and 13.5mm groups(P=0.003,P=0.032).However,there was no significant difference between the 12mm group and the 13.5mm group(P>0.05).A diameter of<5mm before dilation,a diameter of<15mm after initial dilation,and a distance of≥3 months from initial dilation to surgery are risk factors for restenosis within one year after dilation(OR>1,P<0.05).Conclusion For mild to moderate benign stenosis of the anastomotic site afte
作者
余倩玮
章礼久
YU Qianwei;ZHANG Lijiu(Department of Gastroenterology,The Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)
出处
《西部医学》
2024年第12期1844-1848,共5页
Medical Journal of West China
关键词
食管恶性肿瘤
吻合口
良性狭窄
内镜下球囊扩张
Esophageal malignant tumor
Anastomosis
Benign stenosis
Endoscopic balloon dilation
