食管内支架成形术治疗食管良恶性狭窄

目的：评价内支架对食管良恶性狭窄患者行姑息性治疗的临床疗效.方法：入选57例患者,其中食管癌29例,贲门部癌10例,食管癌性狭窄伴食管气管瘘7例,贲门失弛缓症5例,手术后食管良性狭窄6例.病变范围2-14cm,平均7.3cm.病变按吞咽困难分级：I级12例,II级31例,III级14例.46例肿瘤患者在支架置放术后15-30d内进行放射治疗和动脉内化疗灌注联合治疗.结果：57例患者共置入支架62枚,4例患者1次放置2枚,1例患者4个月后因支架移位上段再次狭窄,再次叠放支架.所有病例均1次成功.放置后7-15d梗阻、进食困难症状均明显减轻,7例伴食管气管瘘进食后呛咳立即消失.无严重并发症.5例贲门失迟缓症、6例良性狭窄至今存活.46例恶性患者的6个月存活率为67.4%（31/46）,1年为43.5%（20/26）,2年为26.1%（12/46）,3年为19.6%（9/46）.结论：内支架是治疗食管良恶性疾患有效的姑息性疗法,结合放射治疗和动脉内化疗将明显改善生存质量,提高生存率.良性狭窄采用内支架扩张,其疗效可与外科手术相比.

Objective To evaluate clinical effectiveness and influence factors in the treatment oi benign and malignant esophageal stenosis by placing esophageal stent. Methods A series of this research comprised of 29 Cases with esophageal cancer, 10 cardiac carcinoma, 5 cardiac achalasia, 6 benign esophageal stricture after operation. The lengths of lesion ranged from 2 to 14 cm in length with mean of 7.3 cm. Fistuli were found among malignant esophageal stenosis in 6 cases. According to the dysphagia scores, 1 2 cases were designated as I grade,31 with II,and 14 with III. 46 cases of malignancy were undertaken radiation therapy combined with transcatheter arterial chemotherapy from 15 to 30 days after stent placement, Results 62 stents were placed in 57 cases（52 domestic stents, 10 Boston ultraflex）, including 4 cases with 2 stents being once placed, 1 case with second time stent placement because of restenosis 4 month later. All stents wereplaced successfully without serious complications, such as esophageal perforation, massive hemorrhage. 5 Cases of cardiac aehalasia and 6 cases of benign esophageal stricture are still alive now. The survival rates of 6,1 2,24 and 36 months in 46 malignant cases,were 67.4% （31/46） ,43.5%（20/46）,26.1%（12/46）,and 19.6%（9/46） respectively. Dysphagia were relieved significantly form 7 to 15 days after stent placement. Conclusions Esophageal stent placement combined with radiation therapy and transcatbeter arterial chemotherapy could improve patient life qualities and survival rates significantly in malignant stricture. The effects on benign esophageal stricture by stent placement are comparable with that of surgical treatment.