国产自膨式镍钛记忆合金带膜食管支架的临床应用

The experience of domestic self-expanding nickel-titanium memorial alloying covered stent in the treatment of esophageal strictures

背景与目的：晚期恶性食管狭窄、食管癌或贲门癌术后单纯吻合口狭窄、食管癌放疗后狭窄所致的进食困难甚至出现食管气管瘘、食管纵隔瘘是影响患者生存质量及生存时间的一个重要因素。如何微创、简便、有效的治疗上述食管狭窄或食管气管瘘、食管纵隔瘘一直是临床工作者研究的热点之一。本研究探讨国产自膨式镍钛记忆合金网状带膜支架治疗食管狭窄的价值和注意事项。方法：自1998年4月至2005年10月，我科采用国产自膨式镍钛记忆合金网状带膜支架治疗食管狭窄患者96例（其中食管恶性狭窄65例，包括食管气管瘘18例、食管纵隔瘘3例；食管癌或贲门癌术后单纯吻合口狭窄26例；食管癌放疗后狭窄5例），男性71例，女性25例，平均年龄70岁。所有患者均在X线辅助下行食管内支架置入术。结果：本组共置入食管内支架114枚，均一次成功，成功率100％，近期疗效满意。随访1～60个月，无一例发生支架移位，术后平均生存时间8．6个月。恶性食管狭窄行内支架置入后联合化疗，中位生存期7．4个月。本组患者术后再狭窄率38．5％，予球囊扩张或再次内支架置入治疗（再次介入治疗29．2％）。结论：食管内支架置入是恶性食管狭窄的良好的姑息性治疗手段，也适用于食管癌或贲门癌术后单纯吻合口狭窄、食管癌放疗后狭窄，有助于延长患者生存时间、提高生活质量。但如何降低食管内支架置入后的再狭窄仍有待进一步的研究。

Background and purpose： Dysphagia, caused by either advanced malignant esophageal stricture or anastomotie stenosis after radical operation of esophageal, cardiac carcinoma, esophageal radio-stricture, esophago-tracheal fistula or esophago-mediastinal fistula, has a significant influence on patients＇survival time and quality of life. It has become the focal point in the study on how to less-invasively, conveniently and effectively treat esophageal stricture, esophago-tracheal and esophago-mediastinal fistula. We evaluated the value and points of attantion in the management of esophageal stricture, esophago-tracheal and esophago-mediastinal fistula with domestic self-expanding nickel-titanium memorial alloying covered stent. Methods： Between April in 1998 and October in 2005, 96 patients with esophageal stricture （advanced malignant esophageal stricture 65 cases, including esophago-tracheal fistula 18 cases and esophago-mediastinal fistula 3 cases, simple anastomotic stenosis after radical operation of esophageal or cardiac carcinoma 26 cases, and esophageal radio-stricture 5 cases） have been studied. The age of the patients was from 55 to 87 years with 71 males and 25 females. The patients were treated by domestic self-expanding nickel-titanium memorial alloying covered stent. The most dominant symptom was dysphagy. Results： Successful positioning and deploying of 114 stents in esophageal lumen were achieved in 96 cases. All the patients with symptom of dysphagy had been improved. Esophago-trancheal and esophago-mediastinal fistula were blocked successfully by stent, all the patients could eat either common or semi-liquid food smoothly. Following-up is from one month to 60 months, stent displacement or perforation of esophagus was not found in any of the cases. Re-obstruction of the stent occurred in 38.5% of the cases, the main cause for the re-obstruction was due to disease progression, and 29.2% of the cases had to receive re-interventional therapy. Conclusions： The treatment of malignant esophageal stricture and esophago-tracheal fistula, esophago-mediastinal fistula with domestic self-expanding nickel-titanium memorial alloying covered stent is a safe, convenient, effective palliative method, it could improve the survival time and quality of life. And the procedure can be used for either anastomotic stenosis after radical operation of esophageal, cardiac carcinoma or esophageal radio-stricture. However, how to minimize re-obstruction needs further inverstigation.