不同直径支架对食管恶性狭窄的安全性与疗效评价

Clinical study on the treatment of malignant esophageal stricture with expandable stents of various calibers

目的探讨放疗后食管狭窄及食管癌合并食管气道瘘者应如何选用不同直径食管支架。方法2001年6月—2004年10月共诊治60例食管癌性狭窄患者,其中26例食管癌性狭窄合并食管气道瘘（18例有放疗史,8例无治疗史）,34例放疗后再狭窄（放疗6个月以内者4例,6个月-1年者7例,1年-2年者16例,3年者5例,4年者2例）,根据食管病变长度及有无治疗史选择支架直径,无治疗史者2例选用20 mm支架,6例选用18mm支架,放疗后狭窄合并食管气道瘘者18例均用16 mm支架,单纯狭窄8例选用18 mm支架,26例用16 mm支架。结果60例患者共放置61枚食管内支架,技术操作全部成功,1例单纯狭窄放置18 mm支架者术后3天仍疼痛难忍,将支架取出,2例放置18 mm支架患者（放疗后食管狭窄合并食管气道瘘）分别于术后24天、28天大出血死亡,1例单纯狭窄放置18 mm支架者术后3天大出血死亡,2例放置20 mm支架者,1例术后疼痛持续存在,并于1个月后大出血死亡,另1例术后4天大出血死亡,放置16 mm支架者及放置18 mm支架无放疗史者未出现严重并发症。结论放疗后食管狭窄宜选用较细（16 mm）支架,20 mm支架不宜用于食管气管瘘患者。

Objective To comment on the size of the expandable stent used for treating varied forms of malignant esophageal stricture. Methods Review was made on 60 cases of malignant esophageal stricture treated by placing expandable stents from June 2001 to October 2004. The series consisted of 8 patients who had no history of radiotherapy and whose strictures were complicated by esophagotracheal fistulae, and 52 patients ho had received radiotherapy previously and were suffering from 18 complicated strictures and 34 simple ones. Results 61 stents were successfully placed in the 60 cases, with one placement repeated once. In the patients with no history of radiotherapy, 2 were managed 20 mm stents and both died of massive hemorrhage, while the other 6 all survived the 18 mm stentsing. In the patients with radiotherapy history, 18 mm stents were placed for 8 complicated and 8 simple strictures, with 3 deaths of hemorrhage encountered in them; 16 mm stents were placed in the rest 10 complicated and 26 simple cases and induced no serious complications. Conclusion Expandable stents of smaller caliber （ 16 mm） are of choice in the treatment of esophageal stricture after radiotherapy, The 20 mm stent should not be used for the strictures complicated by esophagotracheal fistula.