Kim Jin Hyoung, Song Ho-Young, Kim Hyo-Cheol, Shin Ji Hoon, Kim Kyung Rae, Park Sang Woo, Jung Hwoon-Yong, Lee Gin Hyug, Park Seung-Il
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul National University Hospital, Seoul, Korea.
J Vasc Interv Radiol. 2008 May;19(5):736-41. doi: 10.1016/j.jvir.2008.01.015. Epub 2008 Mar 17.
To retrospectively evaluate the long-term results of balloon dilation in the treatment of corrosive esophageal strictures and to identify prognostic factors associated with clinical outcome.
From January 1987 to June 2006, balloon dilation was undertaken in 117 patients with corrosive esophageal strictures. Information on recurrence and complications was obtained. Recurrence rates and factors predicting recurrences were evaluated with Kaplan-Meier survival analysis and Cox multivariate analysis. Tested variables were age, sex, corrosive agent, stricture length, stricture number, severity of stricture as judged by the resistance to dilation, and stage (early chronic [3 weeks to 6 months] vs late chronic [>6 months]).
The mean follow-up period was 51 months (range, 1-174 months). Thirty patients (26%) had no recurrence after initial balloon dilation. Twenty-three patients (20%) experienced no recurrence after one or two additional balloon dilation procedures. Forty-five of 117 patients (38%) experienced esophageal rupture (mostly intramural rupture). Early chronic stage (P=.003) and resistance to balloon dilation in the late chronic stage (P=.034) were significantly associated with recurrence after balloon dilation.
Balloon dilation is associated with minimal complications and is valuable as an initial therapy in patients with corrosive esophageal stricture. However, the recurrence rate after balloon dilation is rather high, with early chronic stage and resistance to dilation in the late chronic stage associated with poor clinical outcome. An algorithm combining balloon dilation with temporary stent placement is proposed for the subsets of patients prone to stricture recurrence.
回顾性评估球囊扩张术治疗腐蚀性食管狭窄的长期效果，并确定与临床结局相关的预后因素。
1987年1月至2006年6月，对117例腐蚀性食管狭窄患者进行了球囊扩张术。获取了复发和并发症的信息。采用Kaplan-Meier生存分析和Cox多变量分析评估复发率及预测复发的因素。检测的变量包括年龄、性别、腐蚀剂、狭窄长度、狭窄数量、根据扩张阻力判断的狭窄严重程度以及分期（早期慢性[3周至6个月]与晚期慢性[>6个月]）。
平均随访期为51个月（范围1 - 174个月）。30例患者（26%）在初次球囊扩张后未复发。23例患者（20%）在进行一或两次额外的球囊扩张术后未复发。117例患者中有45例（38%）发生食管破裂（大多为壁内破裂）。早期慢性期（P = 0.003）和晚期慢性期球囊扩张阻力（P = 0.034）与球囊扩张术后复发显著相关。
球囊扩张术并发症极少，作为腐蚀性食管狭窄患者的初始治疗方法很有价值。然而，球囊扩张术后复发率相当高，早期慢性期和晚期慢性期的扩张阻力与不良临床结局相关。对于易于发生狭窄复发的患者亚组，建议采用球囊扩张术与临时支架置入相结合的治疗方案。
