食管贲门狭窄内支架置入术后常见并发症原因及对策

Reasons and countermeasures to complications after stents fixation for palliation of esophageal-cardiac obstruction

目的探讨食管贲门狭窄内支架置入后常见并发症的原因,寻找相应的对策,以减少并发症的发生。方法回顾性分析14例患者置入内支架后出现并发症的病因及相应处置。结果14例患者中,5例患者经X线置入内支架,其余9例均为经内镜置入内支架;11例出现内支架阻塞,2例出现内支架脱落,1例出现内支架移位;肿瘤及炎性组织向腔内生长成为内支架阻塞最常见原因;术后饮食不当以及置入方法欠妥也可引起内支架阻塞、移位甚至脱落;对于组织向腔内生长,可予机械扩张或电烧灼使其再通;食物引起内支架阻塞,可在内镜下取出;内支架移位、脱落,可在内镜下复位或取出重新置入。结论慎重选择适应证、根据病情选择适当的内支架以及提高置入技巧,可降低并发症的发生。

[Objective] To discuss the reasons of complications after stents fixation for palliation of esophagealcardiac obstruction, evaluate corresponding treatment, in order to decrease the occurrence of complications. [Methods] In a prospective study, 14 patients had complications after stents fixation. The reasons and corresponding treatment were analyzed. [Results] Among the 14 cases, 5 cases fixed stents under X-radiation, and 9 cases through endoscopy, 11 cases had stents obstruction; 2 cases had stents fall and 1 case had stent dislocation. Tumor or inflammatory tissue grows towards stent cavity became the commonest reason of stent obstruction; improper method of stent fixation and inappropriate dietary could also cause stents obstruction or dislocation. Stents obstruction caused by tissue growing towards cavity could be reopened by mechanical dilation or electric cautery, caused by lumpish food could be removed through endoscopy; dislocation or fall of the stents could be replaced or take out through endoscopy. [Conclusions] By mastering the indications, selecting proper stents and improving the technique of stent fixation, we can decrease the occurrence of complications.