Couckuyt H, Gevers A M, Coremans G, Hiele M, Rutgeerts P
Department of Internal Medicine, University Hospital Gasthuisberg, University of Leuven, Belgium.
Gut. 1995 Apr;36(4):577-80. doi: 10.1136/gut.36.4.577.
Preliminary reports have suggested that dilatation using hydrostatic through the scope balloons may be useful for the treatment of Crohn's strictures, A prospective longterm follow up (mean (SD) 33.6 (11.2) months) was carried out in 55 Crohn's patients with 59 ileocolonic strictures submitted to 78 dilatation procedures. Hydrostatic balloons were used (Rigiflator, Microvasive) with a diameter of 18 mm on inflation. As soon as the balloons became available dilatation up to a diameter of 20 and 25 mm was attempted. The dilatations were performed under general anaesthesia using propofol (Diprivan). The patients were kept for one night in the hospital after dilatation. Seventy (90%) procedures were technically successful and passage of the stricture with a 13.6 mm diameter colonoscope was possible after 73% of the dilatations. Complications occurred in six patients (11%; 8% of procedures), including sealed perforations (n = 2), retroperitoneal perforations (n = 2), and intraperitoneal perforations (n = 2). Two of the patients were treated surgically with a one stage resection of the stricture and recovered uneventfully. Four patients were treated conservatively with intravenous fluids and antibiotics. There was no mortality. Dilatation completely relieved obstructive symptoms in 20 patients after one procedure, in another 14 patients after two (n = 13) or three (n = 1) dilatations. Total longterm success rate was 34 of 55 patients (62%). Nineteen patients (38%) were operated on because of persistent obstructive symptoms. The data show that endoscopic dilatation using the through the scope hydrostatic balloon system relieves obstructive symptoms resulting from ileocolonic Crohn's strictures. The procedure, however, carries a definite risk of perforation.
初步报告表明，使用经内镜水压球囊扩张术可能对治疗克罗恩病狭窄有效。对55例患有59处回结肠狭窄的克罗恩病患者进行了前瞻性长期随访（平均（标准差）33.6（11.2）个月），共进行了78次扩张手术。使用了水压球囊（Rigiflator，Microvasive），充气时直径为18毫米。一旦有更大直径的球囊，就尝试扩张至直径20毫米和25毫米。扩张手术在全身麻醉下使用丙泊酚（得普利麻）进行。扩张术后患者在医院留院观察一晚。70次（90%）手术在技术上成功，73%的扩张术后能用直径13.6毫米的结肠镜通过狭窄部位。6例患者（11%；占手术的8%）出现并发症，包括封闭性穿孔（2例）、腹膜后穿孔（2例）和腹腔内穿孔（2例）。其中2例患者接受了一期狭窄切除术，术后恢复顺利。4例患者采用静脉补液和抗生素保守治疗。无死亡病例。一次扩张术后20例患者的梗阻症状完全缓解，另外14例患者在两次（13例）或三次（1例）扩张术后梗阻症状完全缓解。55例患者中34例（62%）长期总体成功率较高。19例患者（38%）因持续性梗阻症状接受了手术治疗。数据表明，使用经内镜水压球囊系统进行内镜扩张可缓解回结肠克罗恩病狭窄引起的梗阻症状。然而，该手术存在一定的穿孔风险。
