食管内支架置入术并发症分析

Analysis of Complications of Esophageal Stenting

目的：分析内支架置入术治疗食管良恶性狭窄的并发症并提出防治方法。方法：本组５８例，其中食管化学 烧伤后狭窄２例，食管－胃吻合口狭窄１１例，食管癌３７例，胃贲门癌８例。支架置入在Ｘ线电视监视下进行。术后给予抗 生素、止血药及镇静止痛药，２３例食管癌患者术后行放疗、化疗。结果：１例内支架异位留置，遂加置一根支架，其余５７例 支架均一次置入成功。术后胸骨后疼病２１例，大出血１例。随访１～６个月，食物嵌顿１例，支架移位１例。结论：食管内 支架置入术后以胸骨后疼痛为常见并发症，严重并发症少见。术前准确定位，术中精细操作，术后积极配合其它治疗，是 减少并发症提高手术成功率的关键。

Objective: To analyze the complications of esophageal stent placement in patients with benign and malignant esophageal strictures in order to afford the way to resolve the problems. Methods: Stent implantation was performed under fluoroscopy in 58 cases with esophageal stricture, which included the strictures caused by ingestion of alkali (n=2), esophagogastric anastomotic stenosis ( n =11), esophageal carcinoma( n = 37) ,and cardiac carcinoma( n = 8). Antibiotics, hemostatics and analgesics were postoperatively administered. 23 cases of esophageal cancer post - stenting underwent chemotherapy and radiotherapy. Results: Successful stent placement was achieved in 57 cases at the first trial. One stent was misplaced and another replaced in position in 1 case.Retrosternal pain appeared in 21 cases and large hemorrhage following the stent placement in 1. At follow - up of 1 to 6 months, stent migration was noted in one case and food incar- nation in another. No other complications occurred. Conclusion: Retrosternal pain is one of the most common complications in patients with esophageal stenting. Accurate positioning and careful manipulation of stenting, and active medical management after stenting is the key to the reduction of complications and the success of stenting.