扩张置管术治疗难治性食管狭窄和瘘的研究

Expansion of catheter treatment of refractory esophageal stricture and fistula

目的总结难治性食管狭窄和瘘的种类,探讨难治性食管狭窄和瘘的扩张置管方法、临床应用价值和治疗中应注意的问题。方法选择常规扩张置管比较困难,技术要求较高,常规支架治疗效果不好,反复需要扩张置管或过去认为不宜扩张置管治疗者作为研究对象,共73例。对狭窄病例在内镜或X线下应用气囊扩张器或Sa-vary-Gilliard扩张器扩张治疗,然后置入记忆合金支架。结果 73例患者中有70例一次顺利置入支架,3例因情况复杂第二次置管成功,共放置支架94个。53例食管狭窄患者支架置入术后狭窄处直径由4.0±1.3mm增至18.3±1.2mm(P<0.01)。吞咽困难由2.63±0.42改善为0.91±0.83级(P<0.01);20例食管瘘患者均成功置入支架,食管瘘全部闭合,患者吞咽困难及呛咳症状消失,恢复经口进食,控制了严重感染,病人一般情况明显改善。术后并发症:穿孔0例,出血2例,因扩张引起,内镜止血后出血停止。胸痛67例,用药一周后逐渐缓解。结论据难治性食管狭窄和瘘特点,采取不同的扩张置管方法,可取得较好的临床疗效。

Objective： To summarize the kinds of refractory esoph-ageal strictures and fistulae,to explore the treatment methods with dilation and stents placements,the value of clinical application and problems that attention should be paid to in the treatment.Methods： seventy-three patients were selected in our study,and the patients were difficultly treated with common treatments by dilation and esophageal stents placement.All the cases were implanted self-expanding metal covered stents through mouth under endoscope or X-ray fluoroscopic guidance.And the patients needing dilation were dilated first.Results： 94 stents were successfully implanted in 73 patients with 2 small bleeding and none perforation.Tthe stents were implanted in 70 cases for the first time well,and 3 patients for the second time because of something.The diameters of the strictures were expanded from 4.0±1.3mm to 18.3±1.2mm（P〈0.01） after the stents placements in 53 patients with esophageal strictures and the dysphagia score improved form 2.63±0.42 to 0.91±0.83（P〈0.01）.All fistulae were sealed immediately after covered stents were placed in the 20 patients with esophageal fistulae and the severe pulmonary infections were controlled.Chest pains in 67 cases were gradually relieved after a week medication.Conclusion： Dilation and stents placements through different methods according to the characteristics of refractory esophageal strictures and fistulae can obtain good clinical curative effects.Implantation of self-expanding covered metal stents is an easy,safe and effective procedure in treating esophageal strictures and fistulae.But it is very important to study complications and adopt the method before the use of esophageal stents.