食管支架种类及材料学特征与中晚期食管癌合并食管恶性狭窄、食管瘘的临床应用

Material characteristics and clinical application of esophageal stents for treating advanced esophageal carcinoma complicated by malignant esophageal stenosis and esophageal fistula

目的:探讨不同类型食管支架的材料学特征及其在中晚期食管癌合并食管恶性狭窄、食管瘘中的临床应用效果。方法:由第一作者采用电子检索的方式,在中国期刊全文数据库(CNKI:1999/2009)及Medline数据库(Pubmed:1997/2009)中检索有关不同类型食管支架的材料学特征及其在中晚期食管癌合并食管恶性狭窄、食管瘘中临床应用的文献,排除Meta分析及重复性研究,共纳入22篇文章。结合病例进行结果分析。结果:随着诊疗水平的提高,应用食管支架治疗中晚期食管癌合并的食管恶性狭窄、食管瘘,取得了较为满意的效果。现在广泛应用的食管支架材料有wallstent支架、"Z"型支架、记忆金属支架、防反流金属支架、聚酯塑料支架等。阜新矿业集团总医院2000-11/2009-10采用食管支架置入治疗中晚期食管癌71例,取得较为满意的效果。患者置入支架后吞咽困难迅速得到缓解,有效率达100%。置入后患者均有不同程度疼痛及异物感,多可耐受。3例塑料支架移位和脱落,28例胃食管反流,1例大出血置入后12h死亡,18例远期再狭窄。结论:不同材料的食管支架置入治疗中晚期食管癌合并食管恶性狭窄、食管瘘有其各自的优缺点。wallstent支架置入后异物感明显,但不易移位。"Z"型支架更适应弯曲变形的病变部位及良性病变,支架易于调整和可以回收,并能减少支架再狭窄的发生。记忆金属支架与组织生物相容性好,支架的柔软性好,患者的异物感较轻。防反流金属支架使反流发生率明显降低。

OBJECTIVE：To explore the material characteristics of different types of esophageal stents and their clinical effect in advanced esophageal carcinoma patients complicated by malignant esophageal stenosis and esophageal fistula.METHODS：A computer-based online retrieval was performed by the first author on China Academic Journals Full-text Database（CNKI） from 1999 to 2009 and Medline database（Pubmed） from 1997 to 2009 for articles related to the material characteristics of different types of esophageal stents and their clinical effect in advanced esophageal carcinoma patients complicated by malignant esophageal stenosis and esophageal fistula,Meta analysis and reproducible study were excluded,and a total of 22 articles were included.The results were analyzed with case.RESULTS：With the developing techniques of the diagnosis and treatment,esophageal stent has achieved satisfactory results in the treatment of advanced esophageal carcinoma complicated by malignant esophageal strictures and esophageal fistula.The widely used esophageal stent materials are wallstent esophageal stent,＂Z＂ shaped stent,memory metal stent,anti-reflux metal stent,and polyester plastic stent,etc.Seventy-one patients with advanced esophageal cancer were admitted to General Hospital of Fuxin Mining Group between November 2000 and October 2009,have achieving satisfactory results through esophageal stenting.After stenting,swallowing difficulties in patients have been alleviated quickly,and the effective rate was 100%.After stenting,patients exhibited different degrees of pains and foreign body sensation,which were almost tolerable.Three cases showed stent displacement and loss,28 cases occurred gastroesophageal reflux,1 died of bleeding 12 hours after implantation,and 18 cases exhibited long-term restenosis.CONCLUSION：Different kinds of esophageal stent materials have its own advantages and disadvantages for the treatment of advanced esophageal cancer with esophageal malignant stenosis and esophageal fistula.Wallstent stent induces obvious foreign body sensation after stenting,but is not easy to shift.＂Z＂ shaped stent is more suitable for diastrophic lesions and benign lesions,it can be easily adjusted and recycled,in addition,it can also reduce the incidence of stent restenosis.Memory metal stent is well biocompatible to tissues and soft,with mild foreign body sensation to patients.Anti-reflux stent significantly lowers the incidence of reflux.