内镜下高频电切联合激光治疗颈段食管癌支架置入术后再发狭窄15例

Combined use of endoscopic high-frequency coagulation and laser for the treatment of restenosis after stent placement in patients with esophageal carcinoma:a report of 15 cases

目的:探讨内镜下高频电切联合激光治疗颈段食管癌支架置入术后再发狭窄的疗效及安全性.方法:本组15例患者经胃镜检查,病理细胞学证实为食管恶性肿瘤,颈段食管癌支架置入术后再发狭窄,癌肿上段距门齿16-20cm;隆起型病变采用内镜下高频圈套电切清除,管状浸润性狭窄病变或不能圈套病变联合激光治疗,并观察治疗前后食管直径大小、狭窄程度改善.结果:15例患者均成功,术后12h顺利进食,无1例发生食管大出血、穿孔并发症,治疗术前狭窄管腔直径约4±2mm,术后约13.5±2mm,1mo后完全有效11例,显著效应3例,有效应1例,无效应0例,有效率100%.结论:内镜下高频电切联合激光治疗食管上段癌支架置入术后再发狭窄,是目前治疗食管狭窄安全、有效的方法之一.

AIM： To investigate the efficacy and safety of combined use of endoscopic high-frequency coagulation and laser for the treatment of restenosis after stent placement in patients with cervical esophageal carcinoma. METHODS： A total of 15 cervical esophageal carcinoma patients with restenosis after stent placement were included in the study. Endo-scopic high-frequency coagulation was used for protruding lesions, while combined use of high-frequency coagulation and laser was used for tubular infiltrating lesions or other types of lesions. The diameter of the esophagus and the extent of stenosis were evaluated before and after treatment RESULTS： All the 15 patients received the surgery successfully and could take food without difficulty 12 hours later. No complications such as esophagus hemorrhage or perforation occurred. Preoperative luminal diameter at the stenosis ranged from 3.8 to 4.2 mm, while improved luminal diameter （12.8 to 13.2 mm） was achieved postoperatively. One month later, 11 patients had a complete response, three patients had partial response, and one patients had minor response. The overall response rate was 100%. CONCLUSION： Combined use of endoscopic high-frequency coagulation and laser is safe and effective for the treatment of restenosis after stent placement in patients with cervical esophageal carcinoma, and can improve patients＇ quality of life.