金属支架治疗食管狭窄的价值

Value of metallic stent in the management of esophageal stricture

目的 评价金属支架治疗食管良、恶性狭窄的价值。方法 采用镍钛合金 (不带膜 )和317L合金 (带膜 )支架治疗食管狭窄 2 7例 (4例食管胃吻合口狭窄、2 3例恶性狭窄 ) ,包括 5例食管呼吸道瘘。置放支架方法为先经胃镜行食管扩张 ,再于X线下置管的二部法。吞咽状况用Neuhaus分级评估。结果 病人术后吞咽分级降低 2个等级。狭窄部直径由 (3 16± 1 83)mm扩张至 (14 6 2± 3 12 )mm(P <0 0 1)。带膜金属支架可使瘘口完全封闭。术后近、远期并发症发生率为 40 7% (11/ 2 7) ,依次为支架移位 3例、出血 3例、剧烈疼痛 2例、再狭窄 3例。结论 金属支架治疗食管恶性狭窄是有效的姑息方法 。

Objective To evaluate the clinical value of expandable metallic stent in the treatment of patients with benign of malignant esophageal stricture. Methods 27 patients underwent implantation of self expanding NiTi or silicon covered 317L Z stent for esophageal stricture. Four patients had benign esophageal stricture and twenty three patients had stricture secondary to esophageal carcinoma. All patients underwent esophageal dilatation using a flexible gastroscope and bougies before implantation of the stent. The stent was implanted under fluoroscopic control. The degree of palliation was graded by dysphagia score (Neuhaus classification). Results Follow up was complete in all patients. The dysphagia was improved significantly. After implantation of stent, the diameter of the stricture increased from(3 16±1 83)?mm to (14 62±3 12)mm(P<0 01). The esophagorespiratary fistula was sealed off. Complications included stent tube migration in 3, massive bleeding in 3, re stricture in 3, and severe pain in 2. Conclusion Expandable metallic stent appears to be an excellent palliative method for malignant stricture and covered metallic stent is specifically effective for esophagorespiratary fistula.