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A review of the practice of fibreoptic endoscopic dilatation of oesophageal stricture.

机译:食管狭窄的纤维内镜下扩张的实践回顾。

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摘要

Over a 5-year period 82 patients underwent 244 fibreoptic endoscopic dilatations for oesophageal stricture. A total of 55 patients had benign peptic oesophageal stricture caused by reflux oesophagitis. Two-thirds of these patients had good symptomatic relief with dilatation combined with medical treatment of reflux, whereas one-third had an unsatisfactory result. The practice of endoscopic dilatation in benign stricture proved to be safe and was cost-effective as the procedure was carried out under intravenous sedation on a day-care basis. Three patients underwent dilatation for achalasia with good results in two cases. There were 16 patients with malignant oesophageal stricture and, in this group, fibreoptic endoscopic dilatation had little role to play in relieving dysphagia and its practice was associated with a substantial morbidity and mortality. Dilatation of malignant strictures facilitated biopsy and was used prior to oesophageal intubation. The virtues of the Atkinson or Celestin tube put in with the Nottingham introducer are summarised. Eight patients developed anastomotic stricture after resection of carcinoma of the oesophagus and dilatation provided only very transient relief of dysphagia in this group. Most anastomotic strictures represented recurrent malignancy and the difficulty in gaining biopsy proof endoscopically is emphasised. We advocate the early use of a CT scan in this situation to make the diagnosis of recurrent malignancy so that, if appropriate, palliative treatment can be instituted while the patient's general condition is good enough to benefit from it.
机译:在5年的时间里,有82例患者因食管狭窄接受了244例纤维内镜下扩张术。共有55例由反流性食管炎引起的良性消化道食管狭窄。这些患者中有三分之二的症状缓解,并伴有反流的药物治疗,但扩张效果不佳。内镜下良性狭窄扩张术被证明是安全的,并且具有成本效益,因为该过程是在日间护理的基础上在静脉内镇静下进行的。 3例因门扩张接受了扩张,其中2例效果良好。有16例恶性食管狭窄患者,在该组中,纤维内镜下扩张在缓解吞咽困难方面几乎没有作用,其实践与大量发病率和死亡率相关。恶性狭窄的扩张促进了活检,并在食管插管之前使用。总结了用诺丁汉导引器插入的阿特金森管或塞莱斯汀管的优点。八名患者在食管癌切除后出现了吻合口狭窄,而扩张仅能使吞咽困难暂时缓解。大多数吻合口狭窄代表复发性恶性肿瘤,强调了在内镜下获得活检证明的难度。我们主张在这种情况下尽早使用CT扫描来诊断复发性恶性肿瘤,以便在适当情况下可以在患者的总体状况良好的情况下开始姑息治疗。

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