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目的 对上胃肠道良性狭窄介入治疗进行随访和评价。方法 85例上胃肠道 (uppergastrointestinaltract,UGIT)良性狭窄患者 ,其中球囊导管扩张术组 (A组 ) 3 5例 ;永久性金属支架扩张组(B组 ) 2 5例 ;暂时性部分带膜金属支架扩张术组 (C组 ) 2 5例。在X线引导下 ,A组 3 5例共进行 67次球囊扩张 ,平均 1 9次 ;B组 2 5例安放部分带膜金属支架 15只 ,不带膜金属支架 10只 ;C组 2 5例安放部分带膜金属支架 2 5只 ,在支架术后 3～ 7d由胃镜取出。治疗前UGIT管腔最窄处直径 0 7～8 5mm ,吞咽困难评分 2～ 4级 ;治疗后UGIT管腔最窄处直径 5 1～ 2 0 0mm ,吞咽困难评分 0～ 1级。所有患者术后随访 6～ 3 6个月 (平均 19 1个月 )。结果 A组术后并发症发生率为疼痛 2 9% ( 10 / 3 5 )、返流 2 3 % ( 8/ 3 5 )、出血 9% ( 3 / 3 5 ) ;超过 6个月的随访患者中 2 0 % ( 7/ 3 5 )复发吞咽困难 ,超过 1年的随访患者中 91% ( 3 2 / 3 5 )复发吞咽困难 ,超过 3年的随访患者中 95 % ( 19/ 2 0 )复发吞咽困难。B组术后并发症发生率为疼痛 4 0 % ( 10 / 2 5 )、返流 60 % ( 15 / 2 5 )、出血 12 % ( 3 / 2 5 )、支架移位 16% ( 4 / 2 5 ) ;超过6个月的随访患者中 2 0 % ( 5 / 2 5 )复发吞咽困难 ,超过 1年的随访患者中 2
Objective To follow-up and evaluate the interventional treatment of benign upper gastrointestinal tract. Methods Totally 85 patients with upper gastrointestinal tract (UGIT) benign stenosis were enrolled. Among them, 35 patients in balloon catheterization group (A group), 25 patients in permanent metal stent expansion group (B group) Metal stent dilatation group (C group) 25 cases. Under X-ray guidance, a total of 67 balloon dilations were performed in 35 cases in group A, with an average of 19 times. In group B, 15 cases were partially plated with metal stent and 10 were nonmetallic stent. Group C 2 5 Cases of metal membrane with some stent 25, 3 ~ 7d after stenting removed by gastroscopy. Before treatment, the diameter of the narrowest lumen of UGIT was 0 7 ~ 8 5mm, and the dysphagia score was 2 ~ 4. The diameter of the narrowest lumen of UGIT after treatment was 51 ~ 200 mm and the dysphagia score was 0 ~ 1. All patients were followed up for 6 to 36 months (mean 19 1 months). Results The incidence of postoperative complications in group A was 29% (10/35), 23.3% (8/3 5%) and 9% (3/35) Among the 20% (7/3 5) patients with recurrent dysphagia, 91% (3 of 25 patients) experienced dysphagia after more than 1 year of follow-up, and 95% (19/20) of patients were followed up for more than 3 years hard to swallow. The incidence of postoperative complications in group B was 40% (10/2 5), reflux 60% (15/2 5), bleeding 12% (3/25) and stenting 16% (4/2 5); 20% (5/25) of the follow-up patients over 6 months had difficulty swallowing and 2 of the follow-up patients over 1 year