1 Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia.
2 St George Clinical School, University of New South Wales, Sydney, Australia.
Otolaryngol Head Neck Surg. 2019 Mar;160(3):567-569. doi: 10.1177/0194599818815164. Epub 2018 Dec 11.
Current therapeutic strategies for pharyngoesophageal stricture, while effective in the short term, are protracted and costly in the longer term. Conceptually, if a stricture can be dilated with minimal tissue injuries, the rate of fibrosis and the resultant stricture recurrence could be reduced. We evaluated a prototype computer-controlled syringe pump device programmed to distend a commercially available balloon dilator at variable rate, asserting incremental lumen distension pressures tailored to the resistive force encountered within the stricture. We completed 17 graded dilatation procedures among 4 total laryngectomy patients. All patients had a short-term response (1 month), with a mean decrement (improvement) in Sydney Swallow Questionnaire score of 448 (total score range, 0-1700; normal <234). The overall procedural tolerability and safety were encouraging; the only complication was the displacement of the voice prosthesis during 1 dilatation. From a technical viewpoint, the main challenge was to maintain the balloon in position during dilatation.
目前针对咽食管狭窄的治疗策略虽然在短期内有效，但从长期来看则较为耗时且昂贵。从理论上讲，如果可以在尽量减少组织损伤的情况下对狭窄部位进行扩张，那么纤维化的速度以及由此导致的狭窄复发率可能会降低。我们评估了一种原型计算机控制的注射器泵设备，该设备可以编程以不同的速度扩张市售的球囊扩张器，施加递增的内腔扩张压力，以适应狭窄部位遇到的阻力。我们在 4 名全喉切除患者中完成了 17 次分级扩张程序。所有患者均有短期反应（1 个月），悉尼吞咽问卷评分平均降低（改善）448 分（总分范围 0-1700；正常<234）。总体治疗过程的耐受性和安全性令人鼓舞；唯一的并发症是在 1 次扩张过程中声门假体移位。从技术角度来看，主要挑战是在扩张过程中保持球囊的位置。
