不同种类覆膜支架在食管恶性狭窄治疗中的临床应用

Clinical application of covered stents in treating esophageal malignant stenosis

目的:探讨食管支架的种类及材料的选择,以及覆膜支架在食管恶性狭窄中的应用。方法:作者用计算机检索中国期刊全文数据库(CNKI:1980/2009)Medline database(1980/2009)据库,检索词分别为"食管癌;狭窄;食管支架;覆膜支架"和"esophageal carcinoma;esophageal stenosis;esophageal stent;fabric-covered metallic stent",语言分别设定为中文和英文。共检索到61篇文献,按纳入和排除标准对文献进行筛选,由作者选择试验、提取资料,交叉核对并进行方法学质量评估,共纳入29篇文献。分别以食管支架的种类、材料学研究及覆膜支架在食管恶性狭窄中的临床应用等问题出发进行归纳和总结,探讨食管支架的适宜材料及覆膜支架在食管恶性狭窄中的临床应用现状。结果:共纳入29篇文献。所有研究均未描述分配隐藏和盲法。结果显示:食管支架按材料不同可分为不锈钢金属支架、记忆金属支架和聚酯塑料支架。而作为组织工程支架的材料又可以分为可降解高分子基质材料和不可降解高分子材料。每种材料的支架都有其优缺点。覆膜支架可有效解除癌肿所致食管狭窄,有效阻止肿瘤向腔内生长,防止再狭窄。结论:覆膜支架是一种治疗食管恶性狭窄和瘘的姑息性疗法,可有效提高患者生活质量,延长生存时间。

OBJECTIVE： To explore the materials and selection of esophageal stents, and to discuss the application of covered stents in treating esophageal malignant stenosis. METHODS： CNKI and Medline databases were retrieved by computer for papers published from 1980 to 2009 with search terms of ＂esophageal carcinoma, esophageal stenosis, esophageal stent, and fabric-covered metallic stent＂. The language was limited for Chinese and English. A total of 61 iteratures were initial searched by computer, according to inclusive and exclusive criteria, 29 literatures were selected by the first author. Problems including esophageal stent category, material selection, as well as application of covered stents in treating esophageal malignant stenosis were reviewed and summarized. RESULTS： Totally 29 literatures were included in this paper. No concealed allocation or blinding method was described in the literatures. According to preparing materials, the stents could be divided into stainless metal stent, memory metallic stent and polyester plastic stent. As tissue-engineered materials, stents could be assigned into biodegradable polymer matrix stent and non-degradable biodegradable polymers stent. Each material stent possesses distinct advantage and disadvantage. The covered stents could relief esophageal stenosis effectively, interrupt tumor growth, and prevent restenosis. CONCLUSION： As a palliative therapy for treating esophageal malignant stenosis, covered stents can elevate patients’ life quality and prolong survival times.