Kim Jin Hyoung, Song Ho-Young, Park Sang Woo, Yoon Chang Jin, Shin Ji Hoon, Yook Jeong Hwan, Kim Byung Sik
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea.
J Vasc Interv Radiol. 2008 Apr;19(4):565-70. doi: 10.1016/j.jvir.2007.11.015.
To evaluate the clinical efficacy and safety of balloon dilation and stent placement in the treatment of early benign anastomotic strictures after gastric surgery.
From 1997 to 2006, 63 patients with early (< or =3 months) benign anastomotic strictures after gastric surgery underwent fluoroscopic balloon dilation or stent placement due to obstructive symptoms. In all patients, balloon dilation was initially performed. Stent placement was indicated in patients who showed poor response to repeat balloon dilation.
Balloon dilations were successfully performed in all 63 patients, with only three intramural tears. Thirty-one of the 63 patients (49%) showed good response to initial balloon dilation and required no further treatment until the end of follow-up or death. Conversely, 32 patients (51%) had poor or no response or recurrence after initial balloon dilation and required multiple balloon dilations (n = 20), stent placement (n = 7), percutaneous gastrojejunostomy (n = 2), and/or surgical revision (n = 3). At multivariate analysis, the anastomotic site was the only independent factor predictive of the response to balloon therapy (P < .001). During a mean follow-up of 12 months, overall clinical success was achieved in 56 of the 63 patients (89%) after a single balloon dilation (n = 31), multiple balloon dilations (n = 20), and stent placement (n = 5).
Balloon dilation is safe and effective for the treatment of patients with early benign anastomotic strictures after gastric surgery. Stent placement can be effective in selected patients with early benign anastomotic strictures refractory to balloon dilation.
评估球囊扩张及支架置入术治疗胃切除术后早期良性吻合口狭窄的临床疗效及安全性。
1997年至2006年，63例胃切除术后早期（≤3个月）出现良性吻合口狭窄且因梗阻症状接受透视下球囊扩张或支架置入术的患者纳入研究。所有患者均首先进行球囊扩张。对重复球囊扩张反应不佳的患者则行支架置入术。
63例患者均成功进行了球囊扩张，仅出现3例壁内撕裂。63例患者中有31例（49%）对初始球囊扩张反应良好，直至随访结束或死亡均无需进一步治疗。相反，32例患者（51%）在初始球囊扩张后反应不佳或无反应或复发，需要多次球囊扩张（20例）、支架置入（7例）、经皮胃空肠造口术（2例）和/或手术修正（3例）。多因素分析显示，吻合部位是预测球囊治疗反应的唯一独立因素（P <.001）。在平均12个月的随访期间，63例患者中有56例（89%）在单次球囊扩张（31例）、多次球囊扩张（20例）及支架置入（5例）后获得了总体临床成功。
球囊扩张术治疗胃切除术后早期良性吻合口狭窄患者安全有效。对于部分对球囊扩张难治的早期良性吻合口狭窄患者，支架置入术可能有效。
