全覆膜可取出支架置入术后常见并发症的原因及对策

Reasons and Countermeasures of Complications after Covered Retrievable Stent Implantation

【目的】探讨全覆膜可取出支架治疗各种原因所致食管良恶性狭窄患者后常见并发症的原因,寻找相应的对策,以减少并发症的发生。【方法】回顾性分析60例患者置入全覆膜可取出支架后出现并发症的原因及相应处置。【结果】60例患者共置入全覆膜可取出支架63个,一次性置入成功60个,二次置入成功3个,其中发生并发症:食物嵌顿5例;胸骨后疼痛6例;胃食管反流1例;支架移位及脱落10例(近端移位3例,远端移位4例,脱落3例);食管再狭窄2例,为肿瘤组织过度生长超过支架上下口引起;吻合口再次发生瘘3例;心律失常1例。支架移位为最常见原因,通过再次内镜下治疗或者更换支架,可以较好的处理并发症。【结论】向患者及家属详细交待支架治疗的原理,合理的饮食控制,根据病情个性化设计支架,提高支架置入技巧,可降低并发症的发生。

[Objective]To discuss the reasons of complications after covered retrievable stent implantation for treatment of esophageal stenosis, and to find corresponding countermeasures to decrease the occurrence of complications. [Methods]In a prospective study, 60 patients had complications after implantation of covered retrievable stent. The reasons and corresponding treatment were analyzed. [Results]Among 60 patients,63 covered retrievable stents were implanted,and 60 stents succeeded at the first time, and 3 succeeded in the second implantation. Five cases had food-bolus obstruction, 6 cases had retrosternal pain, 1 case had gastroesophageal reflux,10 cases had stent fall and move（including 3 proximal replacement,4 distal replacement and 3 stent fall）, 2 cases had esophageal stenosis caused by excessive tumor growth over the edge of stent,3 cases had esophageal anastomostic fistula again, and one had arrhythmia. Stent replacement became the commonest reason, and the complications could be cured by endoscopic treatment or exchanging the stent. [Conclusion] The occurrence of complications could be decreased by explaining the principle of stent therapy to the patients and their family members, controlling food consume, designing individualized stent according to the condition of illness and improving technique of implantation.