自膨式覆膜支架在食管、十二指肠恶性狭窄及瘘的临床应用

Clinical application of covered self-expending stent for malignant esophageal and duodenal strictures or fistulas

目的评价食管、十二指肠恶性狭窄及瘘应用自膨式覆膜支架治疗的价值,探讨支架植入后常见的并发症及处理方法。方法87例上消化道狭窄或梗阻患者中,50例食管恶性狭窄,23例贲门-胃吻合口狭窄,5例胃、十二指肠恶性狭窄,3例食管瘘,6例食管吻合口瘘,共置入国产带膜网状支架95枚。结果内支架置入全部一次成功,除1例患者术中急性出血外,余病例无即刻并发症,术后患者狭窄解除,饮食得到恢复,瘘道封闭,远期疗效与疾病性质和相关治疗情况有关。结论自膨式覆膜支架治疗食管、十二指肠恶性狭窄及瘘疗效可靠,并发症少,术后加放疗和(或)化疗可进一步提高疗效。

Objective To evaluate the value of covered self-expending metallic stent in the management of malignant esophageal and duodenal strictures or fistulas and explore the treatment for the associated common complications. Methods With interventional procedure under fluoroscopic guidance, 95 self-expending mesh stents were implanted in 87 patients, including esophageal carcinoma （50 cases）, esophagogastric anastomotic stenosis （23 cases）, gastroduodenal malignant stenosis （5 cases）, esophagobronchial fistula （3 cases）, esophagogastric anastomotic fistula（6 cases）. Results Stent placement was successful in all patients at the first trial, having no instant complication except one acute bleeding during the procedure and all of them with relief of stenostic complaint, restoration of clictelic function and closure of fistulas. The long-term curative effect showed something to do with different kind of disease, and the related treatment. Conclusion Self-expending metallic covered mesh stent is safe, effective and less complication; and could be further promoted with addition of radiotherapy and（or）chemotherapy.（J Intervent Radiol, 2007, 16： 419-422）