全覆膜可取出金属支架治疗难治性食管良性狭窄

Covered retrievable metal stent in the treatment of refractory benign esophageal stricture

目的评价全覆膜可取出金属支架治疗难治性食管良性狭窄的疗效和安全性。方法选择经内镜扩张治疗失败的难治性食管良性狭窄病例6例,其中化学性烧伤3例,食管胃吻合口狭窄2例,吻合口狭窄、金属支架置入术后再狭窄1例,按病例不同情况设计全覆膜可取出金属支架的形状,置入食管狭窄段,定期观察症状的变化、支架两端黏膜增生情况及支架取出后症状的变化情况。结果所有病例均成功置入支架,支架置入后吞咽困难症状均得到持续改善,能进食软食。支架置入3～6个月后均经内镜成功取出,无1例发生支架端口黏膜增生、支架再狭窄。其中4例支架取出后随访2～12个月,症状持续改善,无需再治疗；另2例发生支架移位,支架取出后1个月内再次出现吞咽困难。1例支架置入术后出现胸骨后疼痛,无其它并发症发生。结论个体化设计的全覆膜可取出金属支架是治疗难治性食管良性狭窄的一种安全、有效的方法。

Objective To evaluate the efficacy and safely of the covered retrievable metal stent in the treatment of refractory benign esophageal stricture. Methods Six patients with refraetory benign esophageal stricture who failed in endoscopic＇ dilation were seleeted, There were 3 eases of strieture after caustic chemieal ingestion, 2 cases of anastomotic, stricture after surgery, and 1 case of re-stricture after metal stenting. The shape and diameter of the covered stent were individually designed. Stent was placed across the esophageal stricture. Symptoms after stenting, mueosal hyperplasia al the ends of stent and symptoms ＇after retrieval of stent were followed up. Results Stent placement was performed successfully in all patients. After the stent placement, dysphagia was resolved,and all patients could consume soft food, Three to six months after stenting, all the stents were removed successfully by endoscopy. No mucosal hyperplasia and re-strieture occurred. In 4 cases, after stent had been removed, followed up for 2 to 12 months, symptoms of dysphagia were resolved persistently, and 110 further treatment was necessary. In the other 2 cases, the stent migrated, and dysphagia recurred within I month after removal of the stent, Besitdes one case of retrosternal pain after stenting, no other eomplieation was holed, Conclusion Individually designed covered retrievable metal stent is a safe and effective way to treat refractory benign esophageal stricture.