大杯口加膜支架在食管下段贲门癌支架术后再狭窄中的应用研究

Study on the application of big cup membranate stent on restenosis after stenting for carcinoma of esophago cardia

目的评价自行设计的大杯口加膜支架在食管下段贲门癌支架术后再狭窄中的应用。方法对12例食管下段贲门癌支架植入后再狭窄患者,在透视下将自行设计由南京微创公司加工生产的大杯口加膜支架(杯口高度3.5cm)置入到已狭窄的支架内,随访观察其疗效、再狭窄情况及其并发症。结果12例大杯口加膜支架植入顺利,无支架杯口的套叠现象。随访1.5～8个月,2例支架大杯口出现重度再狭窄,引起3级吞咽障碍。其中1例发生在支架术后1个月,由大量肉芽组织增生引起。另1例发生在支架术后6个月,由肿瘤组织生长引起;3例在支架术后2.3～7个月(平均4.6个月)发生轻～中度再狭窄引起的1级吞咽障碍。其余7例随访3～8个月(平均5.6个月)未出现吞咽障碍。结论大杯口加膜支架在食管下段贲门癌支架术后再狭窄中的应用,能有效阻止支架下移,减低再狭窄的发生率。

Objective To evaluate the clinical value of self-designed big cup membranate stent on reatenosis after stenting for carcinoma of esophago-cardia. Methods 12 cases of restenosis after stenting for carcinoma of esophago-cardia were involved in the study. Self-designed big cup membranate stent made by Nanjing Weichuang Company （the length of the cup was 3.5 cm）was placed into the constricted stent under guidance of fluoroscopy. Clinical effect, restenosis, and complications were observed during followed up. Results All the 12 cases of big cup membranat stent placement went along smoothly without indigitation of the cup of the stent. Follow-up of 1.5 - 8 months showed that 2 cases developed severe restenosis on the big cup of the stent, resulting in third grade difficult deglutition. Among them, one occurred 1 month after stenting, caused by hyperplasia of large amount of granulation tissue; another occurred 6 months after stenting, caused by growth of tumor tissue. 3 cases developed mild to moderate restenosis, 2.3 - 7 months （mean： 4.6 months）after stenting, with result of first grade difficult deglutition. The remaining 7 cases （mean5.6 months follow-up） did not have difficulty during deglutition. Conclusions Application of big cup membranate stent on restenosis after stenting for carcinoma of esophago-cardia can effectively prevent the stent from moving downwards and thus lower down the rate of restenosis, and postpone the occurrence of restenosis.（J Intervent Radiol, 2007, 16： 478-480）