金属内支架治疗食管恶性狭窄和球囊扩张治疗食管良性狭窄的随访研究

Follow-up Study of Balloon Dilatation for Benign Esophageal Stricture and Stent Implantation for Malignant Esophageal Stricture

目的 研究食管恶性狭窄内支架治疗和良性狭窄球囊扩张的疗效。材料与方法 191例有较完整的随访资料 ,其中 14 9例食管恶性狭窄置入了内支架 ,93例置入支架前后作了放射治疗或化学药物治疗 (占 65 % ) ;42例良性食管狭窄作了球囊扩张治疗。门诊行食管造影和 /或内镜检查随访 115例 ,通过电话或信件随访 3 4例。结果 随访观察 1～ 5 6个月 ,其中 3例支架发生轻度移位 ,但仍能覆盖病变全长 ,未作特殊处理。 42例死亡 ,均为食管癌患者。术后生存时间 2～ 3 4个月 ,平均 9.5个月。恶性食管狭窄内支架置入后再狭窄 2 9例 ,因食物在支架内阻塞 1例 ,因肿瘤生长发生狭窄 2 4例 ,因支架上端组织增生发生狭窄 4例。发生再狭窄的 2 9例均再次作了内支架置入或球囊扩张治疗。结论 内支架置入治疗恶性食管狭窄能有效解除吞咽困难 ;应用带膜支架和同时作放化疗 ,可防止因肿瘤生长发生再狭窄 ,并能有效封堵食管气管瘘 ;吻合口和贲门癌狭窄应用防返流支架 ,可预防返流性食管炎的发生。球囊扩张治疗良性食管狭窄 ,只要扩张充分 ,临床效果良好。

Objective To study the long-term results of balloon dilatation for benign esophageal stricture and stent implantation for malignant esophageal stricture.Materials and Methods Stent implantation was performed in 149 cases with malignant esophageal stricture, of which 93 (65%) received radiotherapy and chemotherapy before and after the stenting procedure. Simple balloon dilatation was done in 42 cases with benign esophageal stricture. Results During a follow up period of 1～56 months, in stent implantation group mild displacement of the stent occurred in 3 cases, 42 cases died with a mean survival period of 9.5 months (2～34 months), and recurrent stenosis occurred in 29 cases, who had to receive balloon dilatation or another sent implantation procedure. The stent was obstructed due to food in one, tumor in 24 and hamartoplasia at the upper end of the stent in 4 cases.Conclusion Stent implantation is an effective palliative treatment for esophageal carcinoma with severe dysphagia. Excellent results can be obtained in balloon dilatation cases with benign esophageal stricture when the stricture is adequately dilated.