食管内支架置入术的复杂并发症及其防治分析

The Analysis on Complication and Management of Esophageal Stent Placement

目的探讨食管内支架置入后出现严重并发症的相关因素及防治对策。资料与方法60例因食管病变行金属内支架置入术患者中,良性狭窄15例,恶性狭窄28例,食管瘘17例。随访观察1～33个月,随访内容包括患者的生存状态、并发症及支架通畅情况,并对影响疗效或威胁生命的并发症作重点分析。结果60例患者置入食管内支架73枚,手术成功率97.3%(71/73)。发生影响疗效的并发症45例,威胁生命的并发症12例。影响疗效的并发症包括支架选择不当3例,支架移位14例,支架再狭窄28例;威胁生命并发症包括术后大出血5例,并发食管瘘5例,支架造成气道受压2例。结论食管内支架置入操作简便、安全、有效,但其复杂并发症的发生不容忽视,其中以再狭窄、支架移位、食管瘘、术后大出血较常见,准确的术前评估、适当的支架选择、熟练的术中操作、定期术后复诊可有效减少并发症的发生率。

Objective To analyze the cause of the complication and management of esophageal stent placemen. Materials and Methods 60 cases with esophageal stenosis （benign 15 cases, malignant 28 cases, fistula 17 cases） were followed up in 1 - 33 months. The quality of life, the complications and the relative causes were analyzed in detail. Results The success rate of the operation was 97.1%. The complications affected the outcomes were in 45 eases, such as restenoses in 28 cases, stent migration in 14 cases, selected the wrong stent in 3 cases. Life-threatening complications included hemorrhage （ n = 5 ）, fistula （ n = 5 ） and tracheal compression （ n = 2 ）. Condusion Placement of esophageal stent is safe and effective, but its complications should be considered. Careful evaluation before placement and accurate operation in the procedure, conscientious observation after the placement and checks regularly after operation can prevent most of the complications.