金属内支架在食管良、恶性狭窄及瘘中的应用

Treatment of Benign and Malignant Esophageal Strictures or Fistulas by Metallic Stent

目的 评价食管内支架治疗食管良恶性狭窄及瘘的临床疗效 ,探讨食管内支架放置成功的操作技术要点。方法 在X线电视导向下对 38例食管良恶性狭窄及瘘患者放置了 4 2根内支架 ,根据是否进行球囊预扩张及内支架两端超过病变的长度分为A组和B组。结果 38根内支架一次置入成功 ,4根内支架二次置入成功。随访 1～ 8个月 ,两组患者放置内支架后吞咽困难症状平均由治疗前 2 .8级降到治疗后 1级 ,瘘口完全封堵 ,6例上胸段患者有持续胸痛不适 (A组 /B组 :5 /1) ,2例食物嵌顿 (A组 /B组 :1/1) ,5例有黑便 1～ 2次 (A组 /B组 :4 /1) ,1例死于呕血 (A组 ) ,1例死于呼吸衰竭 (B组 ) ,3例死于食管癌复发或转移 (A组 /B组 :2 /1)。 3例内支架移位 (A组 )。结论 食管内支架放置成功的技术关键是术前正确定位。同时 ,不进行预扩张或应用直径为 1.0cm球囊预扩张和内支架两端超过病变 2～

Objective To evaluate the clinical effect of treatment for benign and malignant esophageal stricture or fistula by stent and study the technical keys of successful stent placement .Methods 42 stents were implanted in a series of 38 patients with benign and malignant esophageal strictures or fistulas under TV fluoroscopic guidance.The patients were divided into group A and B according to balloon dilatation performing or not and length of stent extending over lesion.Results Stent placement was achieved in 38 stents at one stroke and in 4 stents at two stroke. During follow-up period for 1～8 months, the severity of dysphagia grade was reduced ,on the average ,from 2.8 to 1.0, and the fistulas was completely closed . Retrosternal pain on upper chest occurred in 6 cases (Group A/Group B: 5/1), food impaction occurred in 2 cases (Group A/Group B: 1/1) ,melena was found 1～2 times in 5 cases (Group A/Group B:4/1),1 case (Group A)died of massive hematemesis , 1 case (Group B) died of respiratory failure and stent migration was noted in 3 cases (Group A).Conclusion Accurate positioning is the key to successful stent implantation. It can further reduce complications by disusing balloon dilatation or using balloon dilatation 1 cm in diameter and stent extending over lesion about 2～3 cm.