Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2011 Dec;197(6):1481-6. doi: 10.2214/AJR.11.6591.
The purpose of this article is to investigate the incidence and management of esophageal rupture caused by balloon dilation in patients with benign esophageal strictures.
Fluoroscopically guided esophageal balloon dilation was performed on 589 patients with benign esophageal strictures during an 18-year period. The strictures had a range of causes: postoperative anastomotic stricture, corrosive stricture, postradiation stricture, esophageal achalasia, esophageal reflux, congenital stricture, esophageal web, esophageal ulcer, medication fibrosis, chronic inflammation, and posttraumatic stricture (in descending order of frequency). Esophageal rupture was assigned to one of three categories: type 1 was intramural, type 2 was transmural with a contained leak, and type 3 was transmural with an uncontained mediastinal leakage.
A total of 1421 procedures were performed in 589 patients, with each patient undergoing 1-29 procedures. The technical success rate was 99.8%, and the clinical success rate was 91.7%. Patients with corrosive stricture underwent the highest number of procedures (mean, 4.38 procedures). The incidence of esophageal rupture was 14.7%. All esophageal ruptures were detected immediately after the procedure. Most ruptures (98.6%) were types 1 and 2 and were successfully managed conservatively. Only 1.4% of the ruptures were type 3 and required active management. One of the type 3 ruptures was successfully treated with a retrievable covered stent. Two patients with type 3 ruptures (0.96% of ruptures) underwent surgery and were successfully treated. The rupture rate was not statistically related to the diameter of balloon used.
The incidence of esophageal rupture after fluoroscopically guided esophageal balloon dilation was 14.7%. Almost all ruptures were type 1 or 2 and were successfully managed conservatively. Only 1.4% of the ruptures were type 3 and required active management. There was no procedure-related mortality in any patient. Therefore, in spite of the high incidence of ruptures, fluoroscopically guided balloon dilation is a safe procedure, particularly if a rupture is identified early and managed appropriately.
本文旨在探讨良性食管狭窄患者行球囊扩张治疗后食管破裂的发生率和处理方法。
在 18 年期间，对 589 例良性食管狭窄患者行荧光透视引导下食管球囊扩张治疗。狭窄的病因多种多样：术后吻合口狭窄、腐蚀性狭窄、放射性狭窄、食管贲门失弛缓症、食管反流、先天性狭窄、食管蹼、食管溃疡、药物性纤维化、慢性炎症和创伤后狭窄（按频率降序排列）。食管破裂分为 3 型：1 型为壁内型，2 型为穿壁型伴包裹性漏，3 型为穿壁型伴非包裹性纵隔漏。
589 例患者共进行了 1421 次操作，每位患者进行了 1-29 次操作。技术成功率为 99.8%，临床成功率为 91.7%。腐蚀性狭窄患者接受的操作次数最多（平均 4.38 次）。食管破裂的发生率为 14.7%。所有食管破裂均在操作后立即发现。大多数破裂（98.6%）为 1 型和 2 型，经保守治疗成功处理。只有 1.4%的破裂为 3 型，需要积极治疗。其中 1 例 3 型破裂采用可回收覆盖支架成功治疗。2 例 3 型破裂（破裂总数的 0.96%）患者接受手术治疗并成功治愈。破裂率与使用的球囊直径无统计学关系。
荧光透视引导下食管球囊扩张后食管破裂的发生率为 14.7%。几乎所有破裂均为 1 型或 2 型，经保守治疗成功处理。只有 1.4%的破裂为 3 型，需要积极治疗。任何患者均无与操作相关的死亡率。因此，尽管破裂发生率较高，但荧光透视引导下球囊扩张是一种安全的操作方法，尤其是在早期发现并适当处理破裂的情况下。
