消化管吻合部狭窄に対する内視鏡的切開拡大術の効果と限界

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  • Effects and Limitation of Endoscopic Incisional Dilatation on Castrointestinal Anastomotic Strictures.

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Indications for and limitations of endoscopic dilatation by incision and bougienage as treatment for anastomotic gastrointestinal stricutres were investigated. The subjects were 35 patients with of anastomotic strictures (26 with cicatrical strictures and 9 with cancerous strictures). For cicatrical strictures, the rates of strictures released according to the length of the stricture, were 14/15 (93.3%) for strictures shorter than 2 cm, 8/9 (88.9%) for those between 2 cm and 3 cm, and 0/2 (0%) for those longer than 3 cm. For cancerous strictures, the rate was 0/9 (0%), an unfavorable result. Ten cases showing unfavorable results excluding 3 cases of cancerous stricture (4 cases of cicatrical strictures and 6 cases of cancerous strictures) received some other treatment: Surgery was performed in 3 cases (1 case of cicatrical stricture and 2 cases of cancerous stricture) and intubation of a throughbougie esophageal prosthesis was performed in 7 cases (3 cases of cicatrical strictures and 4 cases of cancerous strictures). Of surgically treated patients, release from the stricture was achieved in only 1, and the others required an exploratory laparotomy or died from complications. Intubation of an esophageal prosthesis was able to release the stricture in all 7 patients, making discharge possible. In only 1 case of cicatrical stricture did the rolled skin flap form a skin fistula, which required an operation. Intubation of a through-bougie esophageal prosthesis was usefull as a non-invasive treatment for intractable anastomotic strictures.

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