不同直径支架治疗高位食管狭窄的近期疗效研究

Short-term effects study on the treatment of malignant upper esophageal stenosis with expandable stents of various calibers

目的探讨不同直径食管支架治疗恶性高位食管狭窄的近期疗效及并发症。方法采用前瞻性临床研究方法对2009年10月至2012年10月收治的60例高位食管癌患者行食管支架置入治疗,根据置入支架直径通过随机数表法分为三组,直径18 mm组(A组)、16 mm组(B组)和14 mm组(C组),每组各20例。观察比较各组临床疗效及并发症。结果所有病例均成功支架植入,成功率100%。三组患者治疗后吞咽困难均得到有效缓解。术后并发症,疼痛:A组最高128次/48 h,B组72次/48h,C组16次/48h,NRS疼痛评分差异有统计学意义(F=26.317,P<0.05);出血:1例患者出现大出血死亡,3例A组及2例B组患者出现少量出血,C组患者未发生出血;会厌功能紊乱发生率:A组40%(8/20),B组20%(4/20),C组5%(1/20),三组差异有统计学意义(χ2=7.267,P=0.02)。结论 14 mm直径支架成形术可有效缓解进食梗阻,且相比18 mm及16 mm直径食管支架安全性高,是高位食管癌支架成形术的最佳选择。

Objective To explore the short-term effects and complications of treatment with various calibers expandable stents for malignant upper esophageal stenosis. Methods A prospective study was made on 60 cases of malignant upper esophageal stenosis treated by placing expandable stents from October 2009 to October 2012. All patients were divided into three groups using random number table method, 20 patients were treated with expandable stents in 18 mm diameter （group A）, 20 patients with 16 mm expandable stents （group B）, and 20 patients with 14 mm expandable stents （group C）. The follow-up in all groups lasted 1 -2 weeks. Clinical effects and complications were compared. Results All the stents were done successfully and dysphagia was relieved effectively. Postoperative complications were as follows, pain： group A 128 times/48 hours, group B 72 times/48 hours, group C 16 times/48 hours, and the differences of NRS pain scores were statistically significant （F =26. 317, P 〈0.05） ; haemorrhage： 1 patient in group A died from massive hemorrhage, 3 patients in group A and 2 patients in group B had a slight bit of bleeding, while there was no hemorrhage in group C; epiglottis dysfunction rates： group A was 40% （8/20）, group B was 20% （4/20） , group C was 5% （1/20）, and there was significant difference in the three groups （X2 = 7. 267, P = 0.02）. Conclusions Expandable stent of smaller caliber （14 ram） is the best choice in the treatment of malignant upper esophageal stenosis which can relieve dysphagia effectively and has a higher safety than 18 mm and 16 mm expandable stents.