Bi Yonghua, Li Jindong, Chen Hongmei, Han Xinwei, Wu Gang, Ren Jianzhuang
Department of Interventional Radiology Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University Department of Ultrasound, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
Medicine (Baltimore). 2018 Sep;97(37):e12316. doi: 10.1097/MD.0000000000012316.
To determine the safety and effectiveness of fluoroscopic guidance biopsy in the diagnosis of serve anastomotic stricture after esophagogastrostomy for esophageal carcinoma.A total of 55 patients with severe anastomotic stricture were enrolled for forceps biopsy between June 2013 and July 2017. Chest computed tomography (CT) and esophagogram were used to determine the location and extent of stricture. Specimens were collected from the site of stricture by using biopsy forceps under fluoroscopic guidance. Stooler's dysphagia score was compared before and after treatment.The technical success rate of fluoroscopic guidance biopsy was 100%, with no serious complications occurred. A total of 38 patients were diagnosed as benign stricture, of which, 2 patients were further diagnosed as cancer by further biopsy, with a missed diagnosis rate of 5.3%, and 1 patient developed squamous cell carcinoma after 5 months. Thus 20 cases were diagnosed as cancer, 3 cases were adenocarcinoma and 17 cases were squamous cell carcinoma. Balloon dilation was performed for 20 patients (33 times) of benign stricture, and 9 patients (10 times) of malignant stricture. A total of 26 esophageal covered stents were implanted for benign restenosis after repeated balloon dilation. A total of 8 esophageal covered stents were implanted for malignant stricture. After esophagus stenting, dysphagia was immediately alleviated. The dysphagia score decreased from 3.4 ± 0.1 to 0.7 ± 0.1 (P < .001) after treatment.Fluoroscopic guidance biopsy is a safe and effective procedure for directing appropriate treatment of anastomotic stricture after esophagogastrostomy, and it may be an alternative approach for patients who cannot tolerate fibergastroscopy.
为确定透视引导下活检在食管癌食管胃吻合术后严重吻合口狭窄诊断中的安全性和有效性。2013年6月至2017年7月，共纳入55例严重吻合口狭窄患者进行钳取活检。采用胸部计算机断层扫描（CT）和食管造影确定狭窄的位置和范围。在透视引导下使用活检钳从狭窄部位采集标本。比较治疗前后的斯托勒吞咽困难评分。透视引导活检的技术成功率为100%，未发生严重并发症。共38例患者被诊断为良性狭窄，其中2例经进一步活检后被确诊为癌症，漏诊率为5.3%，1例在5个月后发生鳞状细胞癌。因此，20例被诊断为癌症，3例为腺癌，17例为鳞状细胞癌。对20例（33次）良性狭窄患者和9例（10次）恶性狭窄患者进行了球囊扩张。对反复球囊扩张后良性再狭窄的患者共植入26枚食管覆膜支架。对恶性狭窄共植入8枚食管覆膜支架。食管支架置入后，吞咽困难立即缓解。治疗后吞咽困难评分从3.4±0.1降至0.7±0.1（P<0.001）。透视引导活检是食管胃吻合术后指导吻合口狭窄恰当治疗的一种安全有效的方法，对于不能耐受纤维胃镜检查的患者可能是一种替代方法。
