Forshaw M J, Maphosa G, Sankararajah D, Parker M C, Stewart M
Department of Surgery, Darent Valley Hospital, Dartford, Kent DA2 8DA, UK.
Tech Coloproctol. 2006 Mar;10(1):21-7. doi: 10.1007/s10151-006-0246-5. Epub 2006 Mar 15.
The development of anastomotic strictures following colorectal surgery is a frequent problem, but commonly used treatments (e.g. dilatation or revisional surgery) are often ineffective. This study assessed the efficacy of self-expanding metallic stents (SEMS) and endoscopic transanal resection of strictures (ETARS) in managing high-grade benign colorectal anastomotic strictures after the failure of first-line therapies.
All patients with biopsy-proven benign anastomotic strictures (luminal diameter<7 mm) following colorectal surgery, seen in the period April 1995-October 2004, were treated with either SEMS or ETARS.
In the study period, we treated 10 patients (7 men) of median age 71 years. Ten ETARS procedures were performed in six patients, with a mean operating time of 42 minutes and a median hospital stay of 1 day. Early complications of ETARS included: re- operation for bleeding, asymptomatic anastomotic perforation and technical failure in an acutely angulated stricture. SEMS were successfully inserted into five patients (including two with failed ETARS) without any early complications. Overall, nine patients have had satisfactory longterm outcomes (median follow-up, 29 months; range, 3-75 months).
SEMS and ETARS are simple, safe and effective methods in treating high-grade anastomotic strictures.
结直肠手术后吻合口狭窄的发生是一个常见问题，但常用的治疗方法（如扩张或修复手术）往往无效。本研究评估了自膨式金属支架（SEMS）和内镜经肛门狭窄切除术（ETARS）在一线治疗失败后处理高度良性结直肠吻合口狭窄中的疗效。
1995年4月至2004年10月期间诊治的所有经活检证实为结直肠手术后良性吻合口狭窄（管腔直径<7mm）的患者，均接受了SEMS或ETARS治疗。
在研究期间，我们治疗了10例患者（7例男性），中位年龄71岁。6例患者进行了10次ETARS手术，平均手术时间为42分钟，中位住院时间为1天。ETARS的早期并发症包括：因出血再次手术、无症状吻合口穿孔以及锐角狭窄的技术失败。SEMS成功植入5例患者（包括2例ETARS失败患者），无任何早期并发症。总体而言，9例患者获得了满意的长期疗效（中位随访29个月；范围3 - 75个月）。
SEMS和ETARS是治疗高度吻合口狭窄的简单、安全且有效的方法。
