Ductal stenosis dilatation and angioplasty

  Stenosis of the gastrointestinal tract, biliary system, and tracheobronchus can be treated by balloon dilation and placement of props.  I. Gastrointestinal stenosis Gastrointestinal stenosis was mainly treated by surgery, but balloon dilatation treatment was started in 1982.  (A) Indications and contraindications 1. Indications Esophageal stricture, benign pyloric obstruction, anastomotic stenosis after upper gastrointestinal anastomosis, cardia incontinentia that is not suitable for surgery. Esophageal cancer obstruction and esophageal cancer with tracheal fistula can also be treated with brace.  2. Contraindications Inflammatory phase after esophageal burns, anastomotic stricture occurring within 3 weeks after upper gastrointestinal anastomosis.  (II) Operation technique The catheter and guidewire are fed together into the esophagus under fluoroscopy, and the guidewire is manipulated to pass through the stenosis. The selected balloon catheter is fed along the guidewire so that the middle of the balloon is placed at the stenosis and the balloon is inflated to expand the stenotic lesion.  (C) Efficacy Balloon dilation has good efficacy for post-burn esophageal strictures, esophageal webbing and other congenital strictures; upper gastrointestinal anastomotic strictures, with an efficiency of about 90%.  (iv) Complications are generally rare. The more serious complication is gastrointestinal perforation. Local mucosal bleeding and edema can occur after balloon dilatation, which can be relieved in a few days.  Biliary stenosis Biliary stenosis can cause obstructive jaundice, with surgical conditions, surgical treatment is more effective, but the patient is traumatic and recovery time is long, for this reason, interventional treatment methods have been developed.  (a) Benign bile duct stenosis Balloon dilatation First, percutaneous hepatic puncture cholangiography is performed to clarify the site and degree of bile duct stenosis. Then, using the percutaneous hepatic puncture route, a guidewire is placed into the bile duct and passed through the stenotic segment, whereby the catheter is fed into the balloon catheter after dilating the puncture channel, and the balloon is placed in the stenotic segment and inflated to dilate the stenosis. Dilation is completed. If the results are satisfactory, an external drainage tube can be placed through the puncture channel and drained for several days.  (B) Malignant bile duct stricture supporter treatment For malignant bile duct stricture that cannot be treated surgically, the original use of internal drainage can be made of a plastic catheter for permanent internal drainage. The proppant drainage is currently used to be superior to the former. The brace used for biliary system is a self-expanding brace, which is placed through the catheter and expands by metal elasticity to support the bile duct stricture. If the tumor growth obstructs the supporter, a rotational catheter for vascular intervention can be used to remove the tumor and reopen the supporter.  Tracheobronchial stenosis Since the 1980s, self-expanding supports have been used to treat tracheobronchial stenosis, tracheal softening and airway collapse. Postoperative tracheobronchial anastomotic stenosis after lung cancer can be treated with a proppant. The application of a brace is of limited value for neoplastic stenosis.  Four, benign prostatic hyperplasia The incidence of hypertrophy of the prostate is higher in the elderly. Most of them cause urethral strictures and obstructive changes, which used to be treated mainly by surgery. The use of balloon catheter dilation and brace treatment is less damaging to the patient and has better results.