无X线监视内镜下单次双食管覆膜支架置入术:附24例晚期食管癌的治疗

One time insertion of double covered metal stents without fluoroscopy:palliation therapy in 24 patients with advanced esophageal cancer

目的探讨无X线监视的内镜下单次双食管覆膜支架置入术治疗晚期食管癌的操作方法和临床效果。方法对24例肿瘤狭窄长度≥12cm的晚期食管癌患者采用内镜下单次置入2枚食管覆膜支架,所有操作均未采用X线监视。观察指标包括操作成功率、吞咽困难缓解和复发情况、并发症发生率以及患者术后3、6个月生存率。结果 24例患者共置入支架48枚,操作成功率100%。术后吞咽困难分级均下降1～3级,支架置入术后平均130d(38～225d)吞咽困难复发,10例(41.7%)患者术后出现胸骨后疼痛,1例(4.2%)发生支架移位。术后3、6个月生存率分别为83.3%、33.3%。结论无X线监视的内镜下支架置入术是安全可行的,单次双食管覆膜支架置入术可缓解晚期超长食管癌引起的吞咽困难,有效封堵癌性瘘,改善患者生存质量和生存期。

[Objective] To investigate the technical method and clinical result of placement double covered metal stents without fluoroscopy for palliation of advanced esophageal cancer.[Methods] 24 patients with malignant stricture length≥12cm were treated by insertion of double covered metal stents without fluoroscopic guidance.During the follow-up period,the technical success rate,dysphagia score before and after procedure,complications,and patient survival were evaluated.[Results] 48 stents were inserted in 24 patients,the technical success rate was 100%.The dysphagia score at least improved 1 after the procedure.During the mean follow-up of 130 days（range,38~225 days）,patients developed recurrent symptoms of dysphagia.Retrosternal pain occurred in 10 patients（41.7%）,stent migration occurred in 1 Patient（4.2%）.The 90-and 180-day survival rates were 83.3% and 33.3%,respectively.[Conclusions] Stent placement under direct endoscopic vision without fluoroscopy is feasible and safe.One time insertion of double covered metal stents is the sole therapy for extensive malignant esophageal stricture,and is effective to relieve dysphagia,treat fistula and improve life quality.