食管支架术后支架贴壁不良综合征的初步探讨

Preliminary investigation of esophageal stent dys-seal syndrome

目的探讨食管支架置入术后贴壁不良综合征(dys-seal syndrome,DSS)的发生原因及相关处理。方法收集我科2001年6月至2008年6月行食管支架手术患者98例,共置入99枚金属支架。其中术后吻合口肿瘤复发狭窄19例,术前有食管癌放疗病史26例,伴食管-气管瘘34例。结果术后7例患者出现DSS(发生率7.1%)。其中有放疗病史及梗阻上段食管明显扩张患者DSS发生率明显升高(χ2=0.017,0.005,P=0.036,0.013)。经禁食,静脉输液或鼻饲等营养支持治疗后,1例患者逐渐恢复至进食半流质;1例于原支架上端再次置入较大直径支架,术后症状无缓解,后失访;2例改行鼻饲管置入;余3例内镜下取出支架。结论食管支架置入术后发生DDS为并发症之一,临床处理预后不良。取出已经置入的支架是较好的治疗措施。应在术前进行适当的评估以排除危险因素,选择合适的支架,加强围手术期管理等有助于DSS的预防。

Objective To investigate the causes and managements of dys-seal syndrome（DSS） developed after esophageal stent placement.Methods From June 2001 to June 2008, esophageal stenting was performed in 98 consecutive patients with malignant esophageal obstruction.A total of 99 metallic stents were used.Of 98 patients, gastroesophageal anastomosis stricture was seen in 19, preoperative radiotherapy history in 26 and tracheoesophageal fistula in 34.Results DSS occurred in 7 patients, with an occurrence rate of 7.14%, which was significant higher than that in patients with preoperative radiotherapy history and in patients showing marked dilated esophagus proximal to the obstructed site（χ2 = 0.017, 0.005, P = 0.036, 0.013, respectively）.After treatment, such as fasting, TPN or nasogastric feeding, only 1 case returned to semi-liquid diet.Among the rest 6 cases of DSS, an additional stent was employed in one（but in vain）, nasogastric feeding tube was used in 2, and removal of the stent under endoscopic guidance was carried out in 3.Conclusion DSS is one of the complications developed after esophageal stent placement, its prognosis is rather poor.Removal of the inserted stent may be the optimal treatment.The prevention of DSS includes proper pre-operation evaluation, selection of suitable stent, enhancement of perioperative nutritional support, etc.