钛镍合金食管加膜支架治疗食管狭窄及瘘17例分析

Covered nitinol stents in 17 patients with malignant or benign esophageal strictures and fistula

目的回顾分析MTN型形状记忆钛镍合金食管加膜支架对晚期食管癌及高位食管重度良性狭窄患者吞咽困难的治疗效果及并发症的防治。方法对17例晚期食管癌及高位食管重度良性狭窄吞咽困难患者,行食管狭窄探条扩张术后,在内镜直视下或X光监视下置入MTN型形状记忆钛镍合金食管加膜支架,并观察其对吞咽困难的治疗效果。结果17例患者均顺利置放MTN型形状记忆钛镍合金食管加膜支架,患者吞咽困难即刻得到缓解,吞咽困难计分由治疗前的2.88分降至治疗后的1.46分(P<0.01)。主要并发症有胸痛、胃食管反流、支架移位、食团阻塞、再狭窄等。2例高位重度良性食管狭窄患儿支架置放时间达4、5年。结论MTN型形状记忆钛镍合金食管加膜支架能明显改善晚期食管癌及食管良性狭窄患者的吞咽困难,提高生活质量,延长其生存时间。

[Objective] To evaluate the clinical effect and safety of covered nitinol stents in 17 patients with advanced esophageal cancer and/or esophageal fistula or severe benign esophageal strictures. [Methods] 17 patients with advanced esophageal cancer and/or esophageal fistula or severe benign esophageal strictures were treated with covered nitinol stents. After esophageal dilation, a covered nitinol stent was inserted and released on the site of stenosis or fistula. [Results] Stent placement was succeeded with no procedural complications and immediate relief of dysphagia was observed in all 17 patients. The dysphagia score decreased from 2.88 to 1.46 （P〈0.01）. The main complications were： chest pain, gastroesophageal reflux, stent migration or obstruction, and new stricture formation. 2 kids with severe benign esophageal strictures were successfully placed stents for 4-5 years. [Conclusions] Use of covered nitinol stents seems to be a safe and effective method of treatment in selected patients with malignant or be＇ nign esophageal strictures and fistula.