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目的探讨上胃肠道良恶性狭窄或阻塞有效的介入治疗方法和它的优选法及其中远期疗效.方法上胃肠道(upper gastrointestinal tract,UGIT)良恶性狭窄或阻塞患者120例,其中 UGIT 良性狭窄球囊导管扩张术组(A 组)35例;UGIT 恶性狭窄或阻塞永久性无膜和带膜或部分带膜金属支架扩张组(B 组)35例;UGIT 良性狭窄永久性部分带膜金属支架扩张组(C 组)25例;UGIT 良性狭窄暂时性部分带膜金属支架扩张术组(D 组)25例.A 组在 X 线引导下行球囊扩张;B 组、C 组和 D 组在 X 线引导下放置部分带膜和无膜金属支架,D 组在支架术后3d～7d 由内镜取出.所有患者治疗前吞咽困难评分2～4级.结果 A 组35例共进行67次球囊扩张,平均1.9次.B 组35 例安放无膜或部分带膜金属支架35只 C 组25例安放部分带膜金属支架15只;无膜金属支架10只.D 组25例安放部分带膜金属支架25只.B,C 和 D 组支架置入成功率100%;D 组支架取出成功率100%.A 组 UGIT 管腔最窄处直径术前为(3.1±1.7)mm,术后为(8.9±3.3)mm;吞咽困难评分术前为(2.7±1.2)级,术后为(1.1±0.4)级;并发症发生率为疼痛29%(10/35)、反流23%(8/35)、出血9%(3/35);超过1a 的随访患者中91%(32/35)复发吞咽困难.B 组 UGIT 管腔最窄处直径术前为(2.9±2.5)mm,术后为(17.3±2.5)mm;吞咽困难评分术前为(3.1±0.5)级,术后为(1.6±0.7)级;并发症发生率为疼痛20%(7/35)、反流9%(3/35)、出血14%(5/35)、支架移位6%(2/35);超过6mo 的随访患者中17%(6/35)复发吞咽困难,超过1a 的随访患者中50%(15/30)复发吞咽困难.C 组UGIT 管腔最窄处直径术前为(3.1±2.4)mm,术后为(17.7±2.1)mm;吞咽困难评分术前为(2.5±1.1)级,术后为(0.5±0.3)级;并发症发生率为疼痛40%(10/25)、反流60%(15/25)、出血12%(3/25)、支架移位16%(4/25);超过6mo 的随访患者中20%(5/25)复发吞咽困难,超过1a 的随访患者中25%(3/12)复发吞咽困难.D 组 UGIT 管腔最窄处直径术前为(3.3±2.2)mm,术后为(15.1±2.9)mm;吞咽困难评分术前为(2.8±0.9)级,术后为(0.6±0.4)级;并发症发生率为疼痛40%(10/25)、反流12%(3/25)、出血16%(4/25);超过6mo的随访患者中12%(3/25)复发吞咽困难,超过1a 的随访患者中13%(2/15)复发吞咽困难.结论带膜或部分带膜金属支架是 UGIT 恶性狭窄或阻塞介入治疗首选方法;球囊导管多次分级扩张术和暂时性部分带膜金属支架扩张术是 UGIT 良性狭窄介入治疗中的有效方法;在UGIT 良性狭窄介入治疗中远期疗效方面,暂时性部分带膜金属支架扩张术是首选方法.
Objective To investigate the effective interventional therapy of benign or malignant upper gastrointestinal tract and its optimal treatment and its long-term curative effect.Methods Totally 120 patients with benign or malignant stenosis or obstruction of upper gastrointestinal tract (UGIT) 35 cases of stenosis balloon catheterization group (group A), 35 cases of malignant stenosis or occlusion of non-stenosis or obstruction with membranous or partially membranous metal stent (group B), UGIT benign stenosis permanent membranous metal Twenty-five patients underwent stent dilatation (group C) and 25 patients underwent temporary partial dilation of UGIT with benign stenosis (group D) .A group underwent balloon dilatation guided by X-ray; group B, C and D X-ray was placed under the guide with some membrane-free and non-membrane metal stent, D group was removed by endoscopy 3d ~ 7d after stent operation.All patients before treatment dysphagia score 2 to 4. Results 35 cases in group A carried out 67 balls Balloon dilatation, an average of 1.9 times.B group 35 cases of non-membrane or part of the stent with metal stent 35 group C 25 cases of stent placement of metal stent with 15 parts; metal stent without membrane 10. 25 cases of group D with partial membrane Metal stent 25. B, C and D stent implantation success rate of 100%; D group branch The successful rate was 100% in group A. The diameter of the narrowest lumen in group A was (3.1 ± 1.7) mm preoperatively and (8.9 ± 3.3) mm postoperatively, and the grade of dysphagia preoperatively was (2.7 ± 1.2) (1.1 ± 0.4). The incidence of complications was 29% (10/35) in pain, 23% (8/35) in reflux and 9% (3/35) in bleeding; 91% 32/35), the diameter of the narrowest lumen in group B was (2.9 ± 2.5) mm preoperatively and (17.3 ± 2.5) mm postoperatively in group B, and the grade of dysphagia preoperatively was (3.1 ± 0.5) The incidence of complications was 20% (7/35) in patients with pain, 9% (3/35) in reflux, 14% (5/35) in bleeding and 6% in patients with metastasis / 35) .17% (6/35) of the follow-up patients over 6 months had dysphagia and 50% (15/30) had difficulty in swallowing.At the narrowest diameter of the lumen of UGIT (3.1 ± 2.4) mm after operation and (17.7 ± 2.1) mm after operation respectively. The score of dysphagia was (2.5 ± 1.1) preoperatively and (0.5 ± 0.3) postoperatively. The complication rate was 40% (10 / 25), reflux 60% (15/25), bleeding 12% (3/25), stent 16% (4/25); 20% (5/25) , And 25% (3/12) of the follow-up patients over 1a had dysphagia.D group UGIT The diameter of the narrowest lumen was (3.3 ± 2.2) mm preoperatively and (15.1 ± 2.9) mm postoperatively, while the dysphagia score was (2.8 ± 0.9) preoperatively and (0.6 ± 0.4) postoperatively Symptoms were 40% (10/25) of pain, 12% (3/25) of reflux and 16% (4/25) of bleeding; 12% (3/25) of patients who were over 6 months had recurrent dysphagia, 13% (2/15) of the patients with follow-up of 1a had difficulty swallowing.Conclusion The method of interventional treatment of malignant stenosis or obstruction of UGIT is the first choice for patients with or without membranous metal stent.During the multiple grading and balloon dilatation of balloon catheters, Metal stent dilatation is an effective method for the interventional treatment of benign and malignant UGIT. In terms of the long-term curative effect of UGIT for benign stenosis, temporary partial dural metal stent dilatation is the preferred method.