经胃镜下食管支架置入术在治疗食管狭窄中的临床应用

The clinical application of the endoscopic esophageal stenting in the treatment of esophageal stenosis

目的探讨经胃镜下食管支架置入术治疗食管狭窄的临床疗效。方法回顾性分析2005年6月～2009年6月该院收治的食管癌性狭窄病例62例,42例行内镜置入支架(内镜组),20例行X线下置入(X线组),比较两组患者治疗前后扩张效果、吞咽困难变化、并发症以及生存质量情况。结果两组置入食管支架均一次性成功,治疗前后狭窄段直径差异均有显著性(P<0.05)。治疗后内镜组在0、Ⅰ级吞咽困难人数百分率上与X线组比较,差异具有显著性(P<0.05)。X线组胸骨后疼痛及黑便率均高于内镜组(P<0.05),而内镜组在反流性食管炎方面的发病率明显多于X线组(P<0.05)。治疗后患者短期生存率(4个月)内镜组优于X线组(P<0.05)。结论 X线下置入食管支架治疗晚期食管癌性狭窄安全有效,内镜下置入食管支架安全,定位准确,支架覆盖病变完全,临床治疗食管狭窄时应视患者具体情况而定。

[Objective]To evaluate the clinical efficacy of endoscopic esophageal stenting in the treatment of esophageal stenosis. [Methods]The clinical data of 62 cases of esophageal stenosis were retrospectively analyzed from June 2005 to June 2009 in our hospital, The patients were divided into two groups, endoscopy group （42 cases） and X-ray group （20 cases）. The expansion effect and difficulty in swallowing changes were compared in patients before and after treatment, the complications and quality of life situation were also compared as well.[Results] Esophageal stent placement was successful in two groups, the diameter stenosis showed significant difference before and after treatment （P〈0.05）. The ratios of eternum pain and melena of X-ray group were higher than that in endoscopy group （P〈0.05）; The incidence of reflux esophagitis in endoscopy group was higher than that in X ray group, which showed significant difference （P〈0.05）; The short-term survival rate after treatment （4 months） in endoscopic group was better than that in X-ray group （P〈0.05）. [Conclusion]X-ray esophageal stent placement is safe and effective for treatment of advanced esophageal stricture. Endoscopic placement of esophageal stent also proves to be safe, positioning accuracy and complete lesion stent coverage.