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目的分析食管癌和贲门癌切除术后胃狭窄的临床特点,探讨其病因、诊断和治疗方法。方法对1998年1月至2004年12月收治的9例食管癌和贲门癌术后出现胃狭窄患者的临床表现、影像学特征、内镜检查和治疗进行回顾性分析。结果本组男8例,女1例。年龄49～71岁,中位年龄62岁。症状主要为术后吞咽困难。狭窄部位以吻合口以下的胃黏膜缺失,纤维瘢痕增生为主要特征,其长度为1.5～5.0cm,中位长度2.0cm;宽0.1～0.5cm,中位宽度0.3cm。有7例采用单纯食管扩张术均无效,8例施行经口食管支架置入术,可正常饮食。随访期5-60个月,中位时间12个月。支架置入术后再狭窄11例次(包括6例次支架脱落,1例次支架移位,4例次肉芽生长阻塞),颈部切口化脓感染1例,上消化道大出血1例。结论食管癌和贲门癌切除术后胃狭窄应结合临床症状、钡餐和内镜检查进行诊断;治疗首选放置非自扩支架或全覆膜自扩支架。
Objective To analyze the clinical features of gastric stricture after resection of esophageal and gastric cardia and discuss its etiology, diagnosis and treatment. Methods The clinical manifestations, imaging features, endoscopy and treatment of 9 patients with gastric stricture who underwent esophageal and cardiac cancer after operation from January 1998 to December 2004 were analyzed retrospectively. Results The group of 8 males and 1 female. Age 49 to 71 years old, the median age of 62 years. The main symptoms of postoperative dysphagia. The narrow part of the anastomosis below the mucosa of the absence of fiber scar hyperplasia as the main features of its length 1.5 ~ 5.0cm, the median length of 2.0cm; width 0.1 ~ 0.5cm, the median width of 0.3cm. Seven patients with simple esophageal dilation were ineffective, 8 patients underwent oral esophageal stent implantation, can be normal diet. Follow-up period 5-60 months, the median time of 12 months. There were 11 cases of restenosis after stent implantation (including 6 cases of sub-stent detachment, 1 case of sub-stent displacement and 4 cases of granulation growth obstruction), 1 case of cervical incision purulent infection and 1 case of upper gastrointestinal bleeding. Conclusion Gastric stenosis after resection of esophageal and cardiac cancer should be diagnosed in combination with clinical symptoms, barium meal and endoscopy. The non-self-expanding stent or full-stent self-expanding stent is the preferred choice for treatment.