Williamson R C
Br J Surg. 1975 Jun;62(6):448-54. doi: 10.1002/bjs.1800620607.
Eighty-three adult patients with peptic oesophageal stricture are reviewed with regard to diagnosis and treatment. Sliding hiatus hernia was present in 94 per cent of cases. The strictures were graded according to the degree of stenosis encountered at initial oesophagoscopy, but several other factors influenced the management of each case. Bouginage should always be attempted before proceeding to surgery. Thirty-eight patients were treated by bouginage alone, with 21 (55 per cent) good results and 3 deaths. Forty-five patients came to surgery, with 32 (71 per cent) good results and 3 deaths. Six patients sustained instrumental perforation of the oesophagus with 1 fatality. There was in addition 1 case of silent perforation following self-bouginage, which is believed to be unique. Hiatal herniorrhaphy combined with simple bouginage is recommended where reflux oesophagitis dominates the clinical picture. Local plastic repair (oesophagoplasty) has proved a simple and effective method of treating low annular strictures. Oesophagogastrostomy was carried out in 12 patients without operative loss and with good results in 8 cases; the addition of a pyloroplasty is believed to lessen postoperative reflux.
对83例成人食管消化性狭窄患者的诊断和治疗进行了回顾。94%的病例存在滑动性食管裂孔疝。根据初次食管镜检查时遇到的狭窄程度对狭窄进行分级，但其他几个因素也影响了每个病例的治疗。在进行手术之前应始终尝试探条扩张术。38例患者仅接受了探条扩张术治疗，其中21例（55%）效果良好，3例死亡。45例患者接受了手术治疗，其中32例（71%）效果良好，3例死亡。6例患者发生器械性食管穿孔，1例死亡。此外，有1例在自行探条扩张术后发生无症状穿孔，据信这是独一无二的。当反流性食管炎在临床表现中占主导时，建议行食管裂孔疝修补术联合单纯探条扩张术。局部整形修复（食管成形术）已被证明是治疗低位环形狭窄的一种简单有效的方法。12例患者接受了食管胃吻合术，无手术死亡，8例效果良好；加做幽门成形术据信可减轻术后反流。
