食管恶性狭窄内支架治疗和良性狭窄球囊扩张后的随访评价

Follow up study of balloon dilation in benign esophageal stricture and stent implantation in malignant stricture

目的 评价食管恶性狭窄内支架治疗和良性狭窄球囊扩张后的长期随访疗效。方法92例食管狭窄做了内支架或球囊扩张 ,有较完整的随访资料。 5 9例恶性食管狭窄均置入了内支架 ,其中置入支架前后行放射治疗 (简称放疗 )和 (或 )化学药物治疗 (简称化疗 ) 3 7例 ,占 63 % ;3 3例良性食管狭窄做了单纯球囊扩张治疗。内支架置入类型 :国产镍钛记忆合金网孔支架 2 4例 ,带膜支架2 2例 ;国产GianturcoZ形支架 7例 ,带膜支架 4例 ;Ultreflex支架 2例。门诊行食管造影和内窥镜检查随访 78例 ,14例通过电话或信件随访。结果 本组病例经过 1～ 4 1个月的随访观察 ,仅 1例支架发生轻度移位 ,但仍能覆盖病变全长。食管恶性狭窄 17例死亡 ,术后生存时间 2～ 3 0个月 ,平均 8 2个月。死亡原因 :肿瘤多脏器转移 15例 ,心肌梗死 1例 ,其他原因引起死亡 1例。恶性食管狭窄内支架置入后再狭窄 11例 ,因食物在支架内阻塞 1例 ,发生食管 气管瘘 1例 ,因肿瘤组织生长发生狭窄 8例 ,因支架上端组织增生发生狭窄 1例。发生再狭窄的 11例均再次做了内支架置入或球囊扩张治疗。结论 中晚期食管癌内支架置入是解除吞咽困难有效的姑息治疗方法 ,应用带膜支架和同时行放疗、化疗可防止因肿瘤生长而发生再狭窄 ,延缓患者生命。

Objective To evaluate the long term results of balloon dilation in benign esophageal stricture and stent implantation in malignant stricture Methods This series included 59 cases with malignant esophageal stricture treated with stenting Radiotherapy and chemotherapy prior and/or after stenting were done in 37 csases (63%) Simple balloon dilation was performed in 33 cases with benign stricture The stents used included 24 Nitinol stents, 22 Nitinol covered stents, 7 Gianturcu stents , 4 Gianturcu covered stents and 2 Ultreflex stents Follow up with esophagography and esophagoscopy was carried out in 78 cases and with communication in other 14 Results 92 cases were followed for 1-41 months, with mild displacement of stent occurred in one case 17 cases malignant stenosis died with a mean survival of 8 2 months (2-30 months), of which 15 cases were died of widespread carcinoma, 1 case myocardic infarction, and 1 case of other cause Recurrent stenosis occurred in 11 cases after stent implantation Food obstruction in 1 case, trachesophageal fistula in 1 case, hyperplasia at upper end of stent in 1 case, tumor ingrowth in 8 cases Balloon dilation or stent implantation were again performed in 11 cases with recurrent stenosis Conclusions Stent implantation is an effective palliative treatment for esophageal carcinoma with advance dysphasia For those patients with benign esophageal stricture, its effect is obvious in short term while long term result is under investigation