Takeuchi Kunio, Tsuzuki Yasushi, Ando Tetsu, Sekihara Masao, Hara Takashi, Kori Takayuki, Nakajima Hiroki, Asao Takayuki, Kuwano Hiroyuki
Department of Surgery, Tone Chuo Hospital, Gunma University School of Medicine, Gunma, Japan.
Dis Colon Rectum. 2003 Oct;46(10):1430-5. doi: 10.1007/s10350-004-6764-1.
Several methods of treatment for benign anastomotic strictures after anterior resection have been described. We describe a simple, safe, effective, and inexpensive method for treating benign colorectal anastomotic stricture by means of microwave coagulation under flexible colonoscopic visualization.
Eighteen patients with rectal or rectosigmoidal cancer underwent low anterior resection or anterior resection without colonic pouch and colorectal anastomosis by a double-stapling technique with PCEEA. Two of 18 patients (11.1 percent) developed an anastomotic stenosis. A microwave electrode was passed through the biopsy channel of the flexible colonoscope. Under flexible colonoscopic visualization, microwave irradiation was performed at four points (3, 6, 9, and 12 o'clock) in the stricture site because of granulation scar to obtain an adequately coagulated area. No bougies were performed thereafter.
The anastomotic strictures could be dilated adequately, the patients could defecate satisfactorily, and their abdominal distentions and bowel symptoms were resolved. No complications occurred. No occurrence of restricture has been observed.
Flexible endoscopic, microwave coagulation therapy is a useful, simple, effective, and safe method for the treatment of benign colorectal anastomotic strictures.
已描述了几种治疗前切除术术后良性吻合口狭窄的方法。我们描述一种在可弯曲结肠镜直视下通过微波凝固治疗良性结直肠吻合口狭窄的简单、安全、有效且廉价的方法。
18例直肠或直肠乙状结肠癌患者接受低位前切除术或无结肠袋的前切除术，并采用双吻合器技术和术后持续硬膜外镇痛（PCEEA）进行结直肠吻合。18例患者中有2例（11.1%）发生吻合口狭窄。将微波电极通过可弯曲结肠镜的活检通道。在可弯曲结肠镜直视下，由于肉芽瘢痕，在狭窄部位的四个点（3点、6点、9点和12点）进行微波照射，以获得充分凝固的区域。此后未进行探条扩张。
吻合口狭窄得以充分扩张，患者排便满意，腹胀及肠道症状得到缓解。未发生并发症。未观察到狭窄复发。
可弯曲内镜下微波凝固治疗是治疗良性结直肠吻合口狭窄的一种有用、简单、有效且安全的方法。
