高位食管狭窄覆膜食管支架个体化治疗的疗效评估

Covered metallic stents for individualized treatment of proximal esophageal strictures

目的探讨覆膜食管支架治疗高位食管狭窄的疗效及安全性。方法对43例高位食管癌性狭窄患者行覆膜食管支架个体化治疗，统计疗效及不良反应发生情况等。结果43例均成功置入支架，共行45例次支架置人术，其中43例次（95．6％，43／45）一次性置入成功。吞咽困难评分由术前的（3．3±0．6）分改善至术后的（1．8±0．9）分（P〈0．001），其中显效18例次、好转25例次，吞咽困难缓解率为95．6％（43／45）。9例合并食管瘘患者中7例（77．8％，7／9）成功封堵瘘口。发生早期不良反应16例次，包括术后疼痛5例次、气肿1例次、中等度发热9例次和支架上口变形1例次；发生晚期不良反应9例次，包括支架移位3例次和支架上口再狭窄6例次。结论可回收覆膜食管支架个体化治疗高位食管狭窄是安全和有效的，对于封堵食管瘘口亦有较好的临床效果。

Objective To evaluate the efficacy and safety of covered metallic stentts in the manage- ment of proximal esophageal strictures. Methods Retrievable covered self-expanding metallic stents were inserted individually in 43 patients with malignant strictures of the proximal esophagus. Main outcome meas- ures included improvement of dysphagia, sealing of fistula and complications were evaluated. Results A to- tal of 45 stents were placed in 43 patients, with a success rate of 95.6% （43/45） at the first stent place- ment attempt. The dysphagia score improved significantly from 3.3 ±0. 6 to 1.8 ±0. 9 （ P 〈 0. 001 ）, with 18 having an excellent response and 25 having a good response. Improvement rate of dysphagia was 95.6% （43/45）. Fistula sealing was achieved in 7 of 9 patients （77.8%）. Early complications included severe pain （ n = 5 ）, mediastinal emphysema （ n = 1 ）, moderate fever （ n = 9） and collapse of the proximal end of the stent （ n = 1 ）, while late complications included migration （ n = 3） and tissue overgrowth （ n = 6）. Con- clusion Retrievable covered metallic stent placement is effective and safe for the palliation of obstructive dysphagia and sealing of fistulas in malignant proximal esophageal strictures.