支架端改型防治食管支架术后再狭窄的临床应用

Clinical application of mouth-retrofitted stent in prevention of esophageal restenosis after esophageal stent implantation

目的观察支架端改型对食管支架术后再狭窄的防治作用及其安全性。方法 10例经病理及影像学确诊的食管癌患者,用支架端增加硅胶膜的改型支架进行治疗。术后每月随访吞咽困难程度Stooler分级评分、胸部X线片、CT和食管钡餐,了解支架的位置及有无梗阻;每2个月行胃镜检查以了解支架有无狭窄,随访有无严重胸痛、出血、肺炎、食管气管瘘等相关并发症。结果 10例患者随访4～10个月,9例随访期间吞咽困难程度Stooler分级评分均为0～1级,1例吞咽困难程度逐步加重,随访至5个月其程度分级增至3级。术后9例未见支架移位,1例携带125I粒子支架患者随访至8个月时发现支架脱落至胃内,食管钡餐及胃镜检查示原狭窄段管腔内壁较光滑,未见狭窄。1例逐步出现吞咽困难患者的胸部CT扫描提示病变超过支架上缘,食管造影及胃镜证实为肿瘤增生造成再狭窄;其余8例病变长度未见明显增加,食管钡餐及胃镜均未见支架端口狭窄及梗阻征象,其中4例释放未携带125I粒子支架的病变厚度有增加,4例释放携带125I粒子支架的病变厚度较术前变薄。所有患者术后均出现轻度胸痛及咽部不适,经对症处理后均逐步缓解,未出现并发症。结论端口改型支架对食管支架植入术后再狭窄有一定的预防作用且是安全的。

Objective To evaluate the mouth-retrofitted stent in preventing esophageal restenosis after esophageal stent implantation,and to discuss its safety in clinical use.Methods Mouth-retrofitted stent implantation was carried out in 10 patients with pathologically and radiologically confirmed esophageal carcinoma.The mouth part of the stent used in the treatment was covered with silica gel membrane.After the treatment,the patients were followed up monthly to determine the severity of dysphagia,which was assessed by using Stooler＇s score,X-ray.Chest CT scanning and esophagography were performed to observe the location of the stent and to clarify if there was any obstruction.The gastroscopy was bimonthly performed in all patients to see whether or not stent restenosis occurred.If stent restenosis occurred,biopsy examination was used in order to determine its etiology.During the follow-up period,the related complications such as serious chest pain,hemorrhage,pneumonia,trancheoesophageal fistula,etc.were closely observed.Results All the 10 patients were followed up for 4 ～ 10 months.The Stooler＇s score for dysphagia was 0 to 1 grade in 9 cases.The severity of dysphagia was gradually increased in one case and its grade reached 3 at 5 months after the procedure.After operation,no stent migration occurred in 9 cases;in 1 case who had received treatment with the stent loaded with 125I seeds the stent migrated into the stomach after 8 months although both esophagography and gastroscopy showed that the esophageal inner wall of the former stenotic lumen was smooth with no stenosis.In the patient who had gradual increased dysphagia,chest CT scanning showed that the lesion exceeded the superior edge of the stent,and both esophagography and gastroscopy confirmed that the restenosis was caused by tumor proliferation.In the remaining 8 patients,the length of lesions was not obviously increased,and the mouth part of the stent showed no stenosis.Esophagographic and gastroscopic examinations showed that no esophageal obstruction existed.After the therapy the thickness of lesions was increased in 4 patients who used the stent without 125I seeds and the thickness of lesions was decreased in other 4 patients who used the stent with 125 I seeds.After operation,all patients experienced slight chest pain and throat discomfort,which were relieved after symptomatic medication.No serious complications occurred.Conclusion Mouth-retrofitted stent is very effective in preventing the esophageal restenosis occurred after the esophageal stent implantation.Besides,this technique is quite safe.