内镜下球囊扩张术在良性瘢痕性幽门梗阻及球部狭窄中的应用

摘要

目的：将微创治疗应用于良性瘢痕性幽门梗阻及球部狭窄患者中，减少创伤和并发症，改善生活质量。方法：选择本院2011年9月-2012年6月符合条件的36例良性瘢痕性幽门梗阻及球部狭窄患者行内镜下球囊扩张术，并将同期外科手术治疗的32例基线资料相似患者进行对照，所有患者均随访至2014年12月，比较近远期疗效、并发症及治疗成本。结果：球囊扩张组术后2周内镜复查，幽门狭窄口通畅29例，7例患者经再次球囊扩张后幽门狭窄口通畅，平均球囊扩张次数1.19次；其中显效33例，有效3例，总有效率为100%；治疗后幽门口直径为（10.4±1.8）mm，明显大于治疗前，比较差异有统计学意义（t=12.6328， P<0.05）。所有患者随访至2014年12月，平均随访（30.7±2.8）个月，4例患者分别于扩张后14~30个月出现再梗阻后，复发率为11.11%，患者再次行内镜下球囊扩张术后症状缓解，平均球囊扩张次数1.89次。球囊扩张组平均住院时间为（10.6±0.4）d，短于传统手术组，平均治疗费用为（1328.7±154.2）元，低于传统手术组，治疗随访时平均体重明显高于传统手术组，比较差异均有统计学意义（P<0.05）。球囊扩张组扩张时发生胃出血1例，并发症发生率为2.76%，传统手术组并发症发生率为31.25%，比较差异具有统计学意义（P<0.05）。结论：内镜下球囊扩张术操作简便，创伤小，治疗费用和并发症发生率低且疗效确切，是良性瘢痕性幽门梗阻及球部狭窄治疗的理想方法。%Objective:Minimally invasive treatment applied to benign cicatricial pyloric obstruction and duodenal stenosis patients,reduce trauma and complications,improve the quality of life. Method:In our hospital from September 2011 to June 2012 36 cases with the benign cicatricial pyloric obstruction and duodenal stenosis were treated with endoscopic balloon dilatation,and 32 patients were similar to baseline data for the same period surgical operation, all the patients were followed up to December 2014,and compared the prospective efficacy,complications and treatment cost. Result:The balloon dilation group endoscopy 2 weeks postoperatively in 36 patients,pyloric stenosis in patency in 29 cases,7 cases with again after balloon dilation pyloric stenosis in patency,1.19 times the average balloon dilatation. Among them 33 cases were markedly effective,effective in 3 cases,the total efficiency was 100%;after treatment ostial diameter was(10.4±1.8)mm,which was significantly greater than before treatment(t=12.6328,P<0.05). All the patients were followed up to December 2014,were followed up for an average of(30.7±2.8)months,4 patients respectively in the expansion for 14-30 months after re-obstruction,the recurrence rate was 11.11%,again with the endoscopic balloon dilation after the remission of symptoms,the average number of 1.89 balloon dilatation. Balloon dilation group and the average hospitalization time was(10.6±0.4)d,which was shorter than that of the traditional operation group,the average cost was(1328.7±154.2)yuan,which was lower than that of the traditional operation group, treatment follow-up weight were obviously higher than those of traditional operation group(P<0.05). In 1 case of gastric bleeding balloon dilation group expansion,the complication rate was 2.76%. The incidence rate of complications was 31.25%,the difference between the two groups was significant(P<0.05). Conclusion:Endoscopic balloon dilatation of simple operation,small trauma,treatment costs,and a low complication rate and curative effect,and is an ideal method for benign cicatricial pyloric obstruction and duodenal stenosis therapy.