内镜下食管支架置入术57例临床分析

Clinical analysis of esophageal stents implanted under endoscope in 57 patients

目的内镜下治疗食管癌性狭窄及食管气管瘘的疗效分析。方法对57例因食管癌并发癌性狭窄及食管瘘患者采用内镜下放置自膨式覆膜金属支架,其中晚期食管贲门癌性狭窄42例,食管癌放疗后狭窄5例,食管气管瘘4例,术后吻合口狭窄4例及术后吻合口瘘2例。结果 57例病例支架均一次置入成功,未发生与操作有直接关系的并发症,其中除一例食管癌术后并发食管气管瘘患者在支架置入术后短期出现严重DSS（食管支架植入术后贴壁不良综合征）,其余患者吞咽困难及呛咳症状均立即得到不同程度改善,随访1~24个月,其中有34例患者死于晚期肿瘤进展,18例出现再次狭窄,2例出现因支架磨损或病情发展所致食管瘘。结论内镜下食管支架置入能显著缓解因食管狭窄所致的吞咽困难和呛咳并减轻痛苦,提高患者生活质量。

Objective To observe Efficacy of endoscopic esophageal stentings for malignant esophageal stenosis and esophageal fistula.Methods 57 patients were recruited in our study from Nov.2008 to Oct.2010,the strictures were caused by advanced esophagealcarcinoma（n=42）,post radiotherapy strictures（n=5）.Esophagobronchial fistula（n=4）,post operative anastomotic strictures（n=4）,as well as 2 patients with post operative anastomotic fistula.The stents were implanted through mouth under X-ray fluoroscopic guidance.Results All stents were successfully implanted in 57 patients without procedure-related severe complications,except DDC occurred in 1 patients,the dysphagia score improved,and life quality improved significantly in all the patients.Patients were followed up for 24 months,of which 34 patients died of widespread carcinoma,Recurrent stenosis occurred in 18 patients,Esophageal-tracheal fistula was caused by the stent in 2 patients.Conclusion The esophaged stents implantation is an easy,safe and effective procedure for treating dysphagia and cough caused by malignant esophageal strictures.