Holt P D, de Lange E E, Shaffer H A
Department of Radiology, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
AJR Am J Roentgenol. 1995 Apr;164(4):895-9. doi: 10.2214/ajr.164.4.7726043.
Stricture formation resulting in impedance of gastric emptying is a relatively common complication after gastric surgery that involves anastomosis creation or pyloroplasty. Treatment of the stenosis with fluoroscopically guided balloon dilatation avoids further surgery. Accordingly, we report our experience with 32 dilating procedures in 24 consecutive patients who had the postoperative complication of obstruction at a surgically created gastric outlet.
Out of our series of approximately 650 fluoroscopically guided balloon dilatations, 32 procedures were performed on 24 patients with anastomotic strictures or pyloric narrowing after gastric surgery (vertical banded gastroplasty or gastric bypass surgery [n = 15], partial esophagectomy with esophagogastrostomy and pyloroplasty [n = 6], and partial gastrectomy with gastrojejunostomy [n = 3]). The group included 13 men and 11 women ranging from 32 to 79 years old (mean, 51 years). Diameters of the balloons chosen ranged from 10 to 20 mm, depending on the size of the surgically created anastomosis or pyloroplasty. Indications for balloon dilatation were clinical and radiographic evidence of gastric outlet obstruction. The procedures were done between 13 days and 10 years (mean, 14 months) after gastric surgery. The result of each procedure was assessed by evaluating clinical outcome (relief or recurrence of symptoms) during the follow-up period of 2 days to 36 months (mean, 8 months) after the procedure.
In 17 of the 24 patients, the obstructive symptoms were treated successfully with a single dilatation procedure, and symptoms did not recur during follow-up ranging from 1 to 36 months (mean, 11 months). In the other seven patients, the procedure was considered unsuccessful because the patients experienced recurrent obstruction within 2 days to 13 weeks (mean, 3 weeks) after the initial procedure. In one of these, symptoms were relieved by a second procedure. Repeat dilatations in the other six patients were unsuccessful, and all six eventually required surgical revision for definitive treatment. No complicating perforations were noted as a result of dilatation.
Our experience shows that fluoroscopically guided balloon dilatation is a simple and safe technique for treating obstructive symptoms caused by strictures occurring after gastric surgery. In the majority of patients, symptoms are relieved with a single balloon dilatation, eliminating the need for further surgery. However, patients whose obstructive symptoms recur after the initial balloon dilatation procedure are less likely to benefit from further dilatations and usually require surgery.
导致胃排空受阻的狭窄形成是胃手术后相对常见的并发症，这类手术包括吻合口创建或幽门成形术。在透视引导下进行球囊扩张治疗狭窄可避免再次手术。因此，我们报告了对连续24例患者进行32次扩张手术的经验，这些患者在手术创建的胃出口处出现了术后梗阻并发症。
在我们一系列约650例透视引导下的球囊扩张手术中，对24例胃手术后出现吻合口狭窄或幽门狭窄的患者进行了32次手术（垂直束带胃成形术或胃旁路手术[n = 15]、部分食管切除并食管胃吻合术及幽门成形术[n = 6]、部分胃切除并胃空肠吻合术[n = 3]）。该组包括13名男性和11名女性，年龄在32至79岁之间（平均51岁）。根据手术创建的吻合口或幽门成形术的大小，选择的球囊直径范围为10至20毫米。球囊扩张的指征是胃出口梗阻的临床和影像学证据。手术在胃手术后13天至10年（平均14个月）进行。每次手术后，通过评估术后2天至36个月（平均8个月）随访期间的临床结果（症状缓解或复发）来评估手术结果。
24例患者中有17例通过单次扩张手术成功治疗了梗阻症状，在1至36个月（平均11个月）的随访期间症状未复发。其他7例患者的手术被认为不成功，因为这些患者在初次手术后2天至13周（平均3周）内出现了复发性梗阻。其中1例患者通过第二次手术症状得到缓解。其他6例患者的重复扩张手术均未成功，这6例最终都需要进行手术修正以进行确定性治疗。扩张过程中未发现并发症穿孔。
我们的经验表明，透视引导下的球囊扩张是一种治疗胃手术后狭窄引起的梗阻症状的简单且安全的技术。在大多数患者中，单次球囊扩张可缓解症状，无需进一步手术。然而，初次球囊扩张手术后梗阻症状复发的患者从进一步扩张中获益的可能性较小，通常需要手术治疗。
