Hagiwara A, Sonoyama Y, Togawa T, Yamasaki J, Sakakura C, Yamagishi H
Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Gastrointest Endosc. 2001 Apr;53(4):504-8. doi: 10.1067/mge.2001.113281.
Drug therapy plus balloon dilatation without gastroscopic incision does not always relieve postoperative pyloric stenosis.
Five patients with postoperative pyloric stenosis whose symptoms did not improve with drug therapy and balloon dilatation underwent a combination of gastroscopic incision and balloon dilatation. Two or 3 small radial incisions were made in the stenotic muscle of the pylorus electrosurgically at gastroscopy. Then the stenotic muscle layer was loosened and split bluntly along the incisions with balloon dilatation for 15 to 20 minutes. One week later, the combination procedure or balloon dilatation alone was repeated to prevent restenosis.
In the 5 patients, the stenosis was improved with the combination therapy. No complications were observed.
Combined use of gastroscopic incision and balloon dilatation may be considered for patients with refractory pyloric stenosis caused by surgical truncal vagotomy.
药物治疗加不进行胃镜下切开的球囊扩张术并不总能缓解术后幽门狭窄。
5例术后幽门狭窄患者，经药物治疗和球囊扩张术后症状未改善，接受了胃镜下切开术与球囊扩张术联合治疗。在胃镜检查时，用电刀在幽门狭窄肌层做2或3个小的放射状切口。然后，沿切口钝性分离并松解狭窄肌层，同时进行球囊扩张15至20分钟。1周后，重复联合手术或单独进行球囊扩张以防止再狭窄。
5例患者经联合治疗后狭窄情况得到改善。未观察到并发症。
对于因外科迷走神经干切断术导致的难治性幽门狭窄患者，可考虑联合应用胃镜下切开术和球囊扩张术。
