内镜下切开术和球囊扩张术治疗结直肠术后难治性吻合口良性狭窄的疗效比较

摘要

目的 比较内镜下切开术(EI)和内镜下球囊扩张术(EBD)治疗结直肠术后难治性吻合口良性狭窄的疗效.方法 选择济宁医学院附属湖西医院2011年6月至2016年6月收治的结直肠术后难治性吻合口良性狭窄患者72例,其中行EI治疗34例(EI组),行EBD治疗38例(EBD组).比较两组患者术后内镜通畅率、症状缓解率、治疗次数、复发率、末次随访吻合口直径及并发症情况.结果 两组患者均成功完成手术,术后1个月吻合口狭窄均解除且梗阻症状消失.两组术后6个月内镜通畅率和症状缓解率比较差异无统计学意义(P＞0.05);EI组术后12和24个月内镜通畅率和症状 缓解率明显高于EBD组[内镜通畅率:88.2%(30/34)比42.1%(16/38)和64.7%(22/34)比31.6%(12/38),症状缓解率:76.5%(26/34)比42.1%(16/38)和61.8%(21/34)比28.9%(11/38)],差异有统计学意义(P＜0.05或＜0.01).EI组治疗次数和复发率明显低于EBD组[(1.6 ± 0.3)次比(2.6 ± 0.8)次和5.9%(2/34)比73.7%(28/38)],末次随访吻合口直径明显大于EBD组[(1.87 ± 0.23)cm比(1.09 ± 0.18)cm],差异有统计学意义(P＜0.05或＜0.01).两组并发症发生率比较差异无统计学意义(P＞0.05).结论 结直肠术后难治性吻合口良性狭窄采用EI治疗的中长期疗效明显优于EBD且复发率低.%Objective To compare the efficacy between endoscopic incision (EI) and endoscopic balloon dilation (EBD) for refractory anastomotic benign stricture after colorectal surgery. Methods The clinical data of 72 patients with refractory anastomotic benign stricture after colorectal surgery from June 2011 to June 2016 in Huxi Hospital Affiliated to Jining Medical College were retrospectively analyzed. In the patients, 34 cases were treated with EI (EI group), and 38 cases were treated with EBD (EBD group). The postoperative endoscopic patency rate, symptom relief rate, time of treatment, relapse rate, anastomotic diameter at the last follow- up and complication between 2 groups were compared. Results The patients in 2 groups completed the operation successfully, the anastomotic stricture was relieved and the obstruction symptom disappeared 1 month after operation. There were no statistical differences in endoscopic patency rate and symptom relief rate 6 months after operation between 2 groups (P＞0.05). The endoscopic patency rate and symptom relief rate 12 and 24 months after operation in EI group were significantly higher than those in EBD group, endoscopic patency rate: 88.2% (30/34) vs. 42.1% (16/38) and 64.7% (22/34) vs. 31.6% (12/38), symptom relief rate: 76.5% (26/34) vs. 42.1% (16/38) and 61.8% (21/34) vs. 28.9% (11/38), and there were statistical differences (P＜0.05 or＜0.01). The time of treatment and relapse rate in EI group were significantly lower than those in EBD group:(1.6 ± 0.3) times vs. (2.6 ± 0.8) times and 5.9% (2/34) vs. 73.7% (28/38), the anastomotic diameter at the last follow-up was significantly larger EBD group: (1.87 ± 0.23) cm vs. (1.09 ± 0.18) cm, and there were statistical differences (P＜0.05 or ＜0.01). There was no statistical difference in incidence of complication between 2 groups (P＞0.05). Conclusions The mid- and long-term efficacy of EI in the treatment of refractory anastomotic benign stricture after colorectal surgery is significantly better than that of EBD, and the recurrence rate is low.