食管内支架置入后的随访研究

Follow up study of esophageal stent placement

目的食管狭窄置入金属支架后长期随访，观察其疗效和并发症。方法４３例食管狭窄放置了金属支架患者有较完整的随访资料。良性狭窄１４例，恶性狭窄２９例。置入Ｕｌｔｒｅｆｌｅｘ支架３２例，ＧｉａｎｔｕｒｃｏＺ型带膜支架４例，国产网状支架６例，Ｗａｌｓｔｅｎｔ支架１例。门诊随访行食管造影和内窥镜检查２７例，电话或信访１６例。结果１～３２个月随访观察，无支架移位。２４例死亡，术后生存时间１７天至２８个月，平均６．８个月。死亡原因：肿瘤广泛转移１９例，肺部感染２例，其他原因引起死亡３例。发生再狭窄１６例，为支架内或两端发生狭窄。肿瘤组织生长造成的狭窄４例，１２例为食管腔内组织过度增生，这类狭窄全部发生在置入支架后４～５个月。支架内狭窄５例，支架两端狭窄１１例，其中１０例为支架上端狭窄。１２例行再次球囊扩张或支架置入。结论肿瘤的生长，特别是粘膜和纤维组织增生是引起再狭窄的主要原因，支架上端狭窄更容易发生吞咽困难。由于再狭窄的发生率较高，对于良性食管狭窄的支架成型术应严格选择病例。

Purpose To study the long term results of metallic stent placement in patients with esophageal strictures and the complications. Methods 43 patients with esophageal stenosis were followed for 1 - 32 months after inserted metal stents.There were 30 men and 13 women, age ranged from 38 to 83 years (mean, 68 years).14 patients had benign strictures and 29 with malignant. Follow up esophagograms were obtained in 27 patients, endoscopy was done for recurrent stenosis. The remaining 16 patients were followed by means of communicated through mail or phone. Results Stent placement was successful in all patients , no severe procedure related complications occurred . Twenty four patients died with a mean survival of 6.8 months( 17 days to 28 months), 19 died of widespread carcinoma, two pneumonia, 3 for other reasons. 16 patients had recurrent stenosis: tumor ingrowth and overgrowth in four, fibroblastic hyperplasia in 12, stenosis of the upper end of stent in 10. Ingrowth was not observed in patients with coated stents. Conclusion The main causes of recurrent stenosis are tumor growth and especially fibroblastic tissue hyperplasia. Stenosis at upper end of stent was found in the majority of recurrent dysphagia .Proper selection of patients with benign esophageal stenosis is important.