食管记忆金属支架置入食管狭窄及食管、吻合口瘘60例

Esophagus memory Ni-Ti alloy stent for malignant stenosis, esophagus and anastomotic stoma fistula in 60 cases

回顾性分析1995—01／2008—06武警江苏总队医院收治的恶性狭窄及食管、吻合口瘘患者60例，男46例，女14例，年龄36-77岁。均经过病理学确诊，鳞状细胞癌50例，腺癌8例，鳞腺癌2例。60例患者中，食管癌狭窄、食管-贲门癌狭窄33例，食管癌狭窄合并瘘20例，术后食管-胃吻合口与胸腔瘘7例，单发瘘22例，多发瘘5例。全部患者均采用记忆钛镍合金食管加膜支架置入治疗。58例成功置入支架的患者中，21例进食不当造成支架阻塞，经胃镜取出异物后症状缓解，3例移位，在内镜下取出后再次置入，7例3个月后癌肿组织长入管腔造成再狭窄。5例多发性瘘患者中有3例再次置入支架，形成2个支架套叠，成功堵漏。33例食管癌狭窄、食管-贲门癌狭窄中，26例接受了放射治疗加或不加化学治疗，平均生存时间24个月。20例食管癌狭窄合并瘘的患者置入后平均生存时间6个月。7例置入后食管-胃吻合口与胸腔瘘的患者平均生存时间3个月。60例患者中胸骨后疼痛42例，2例疼痛不能耐受取出支架；食管反流20例；未发生出血、穿孔、败血症。提示食管记忆金属支架治疗食管恶性狭窄或食管、吻合口瘘有效，生物相容性好。

Sixty patients with malignant stenosis, esophagus and anastomotic stoma fistula were selected from Jiangsu General Hospital of Armed Police Forces between January 1995 and June 2008, including 46 males and 14 females, aged 36-77 years. Following pathologic diagnosis, 50 patients had squamous cell carcinoma, 8 had adenocarcinoma, and 2 had adeno-squamous carcinoma. Of 60 patients, 33 had esophageal carcinoma stenosis and esophagus-gastric cardia carcinoma stenosis, 20 had esophageal carcinoma stenosis combined with fistula, 7 had esophageal-stomach anastomosis combined with thoracic cavity fistula; in addition, there were 22 cases of first onset of fistula and 5 of multiple fistula. All patients were treated by esophagus memory Ni-Ti alloy coated stent implantation. Of 58 patients with successful implantation, 21 developed stent blockage due to dysphagia, and were alleviated after foreign body removal; 3 developed stent dislocation （removal and re-implanted）; 7 developed restenosis due to tumor tissue ingrowth 3 months after implantation. Of 5 patients with multiple fistula, 3 were re-implanted to form invagination of 2 stents, which succeeded in blocking the fistula. Of 33 patients with esophageal carcinoma stenosis and esophagus-gastric cardia carcinoma stenosis, 26 underwent radiotherapy with or without chemotherapy （mean survival time： 24 months）. Twenty patients with esophageal carcinoma stenosis combined with fistula survived for 6 months averagely. Seven patients with esophageal-stomach anastomosis combined with thoracic cavity fistula survived for 3 months averagely. Of 60 patients, 42 felt retrosternal pain, and 2 patients＇ stents were extracted due to severe pain; 20 patients developed esophageal reflux. No bleeding, perforation or septicemia occurred. The results indicate that memory Ni-Ti alloy stent is effective in treating malignant stenosis, esophagus and anastomotic stoma fistula, showing good biocompatibility.