内支架治疗食管癌性狭窄及瘘的临床应用

Clinical application of metallic stents in treatment of esophageal strictures and fistulae secondary to carcinoma

目的探讨国产自膨式覆膜金属内支架治疗食管癌并发食管狭窄及瘘的临床应用价值。方法对29例食管癌并发食管狭窄及食管瘘患者在X线透视监视下经口置入国产自膨式覆膜金属内支架。其中晚期食管贲门癌性狭窄3例,食管癌放疗后狭窄9例,食管癌或贲门癌术后吻合口狭窄12例,食管癌并发食管气管瘘或食管纵膈瘘5例。结果29例患者共置入内支架31枚,所有病例均一次成功,技术成功率100%。未发生与操作有直接关系的并发症。所有患者支架留置后,吞咽困难立即改善,生存质量提高;6例并发食管气管瘘或食管纵膈瘘者瘘口立即封闭。随访1～12个月,1例内支架移位30mm以上,另1例内支架滑入胃内,这两例患者分别再次叠放支架;3例死亡,其中2例死于晚期食管贲门癌,1例死于食管大出血;4例支架置入后再狭窄;1例因支架端口磨损引起食管-气管瘘。结论虽然金属内支架是一种开通食管、闭塞瘘口的简便、安全、有效的方法,但是应用食管内支架治疗食管癌性狭窄及瘘之前,充分了解可能发生的并发症及处理方法极为重要。

Objective To explore the clinical value of the self-expanding metal covered stents that made in China for the treatment of esophageal strictures and fistulae secondary to carcinoma. Methods Of 29 patients collected in our study, the strictures were caused by advanced esophageal carcinoma （n=3）, post-radiotherapy strictures （n=9）, post operative anastomotic strictures （n=12）, as well as 5 patients with esophageal-tracheal fistula or esophgomediastinum fistula. The stents were implanted through mouth under X-ray fluoroscopic guidance. Results After 31 stents were successfully implanted in 29 patients without procedure-related severe complications （technical successful rate was 100%）, the dysphagia score improved, and life quality improved significantly in all patients. All fistulae were sealed immediately after covered stents were placed in the 5 patients. Patients were followed up 1-12 months, New stents were placed in two patients the stent migrated more than 30 mm in one patient, and the stent slipped into stomach in the other. 3 patients were dead, of which 2 patients were died of widespread carcinoma, 1 patient severe esophageal bleeding. Recurrent stenosis occurred in 4 patients. Esophageal-tracheal fistula was caused by the stent in 1 patient. Conclusion Though implantation of self-expanding covered metal stents that made in China is an easy, safe and effective procedure in treating of esophageal strictures and fistulae secondary to carcinoma. But it is very important to study complications and manage methods before esophageal stents to use.