非自扩支架与自扩金属支架治疗难治性食管良性狭窄的对照研究

Management of refractory benign esophageal strictures with non-self-expandable stents and self-expandable metallic stents

目的评价非自扩支架及自扩金属支架治疗难治性食管良性狭窄的疗效及其优缺点。方法按应用食管支架类型的不同,分成非自扩支架组(23例)、自扩金属支架(SEMS)组(16例),从技术成功率、吞咽功能改善情况、支架的脱落情况、并发症发生率等方面进行临床对照研究。结果全组随访4～60个月,中位数12个月。全组吞咽功能状态:支架置入术前15、21、3例分别为2、3、4级,支架置入术后27、12例分别为0、1级,吞咽功能明显改善(z=-5.531,P=0.000),取得满意的近期效果。非自扩支架及SEMS均可明显改善患者的进食状态。两组的技术成功率均为100%;置支架术后吞咽功能状态两组差异无显著性意义(P=0.107)。非自扩支架组、SEMS组初次置入支架脱落的发生率分别为82.6%(19/23)、6.3%(1/16),差异有显著性意义(P=0.000),再狭窄发生率分别为34.6%、31.3%,差异无显著性意义(P=1.000),但再狭窄的原因不同。结论对于难治性食管良性狭窄,可采用支架治疗,选用非自扩支架在安全性及远期疗效上均优于SEMS。

Objective To Compare the effect between non self expandable stents and self expandable metallic stents in the management of refractory benign esophageal strictures.Methods Thirty nine consecutive patients were classified into two groups according to the type of stent. Group A(23 patients):non self expandable stents(Self made plastic prosthesis, Wilson Cook Esophageal Prosthesis), group B(16 patients): self expandable metallic stents(SEMS). A comparative study was made on several aspects including the rate of technical success, the degree of swallow function(express as dysphagia score), the rate of stent dislocation and the incidence of complications.Results The follow up time was from 4 to 60 months and the median was 12 months. The grades of swallow function in this series were 2, 3 and 4 in 15, 21 and 3 cases respectively before stenting, 0 and 1 in 27 and 12 cases respectively after stenting. Obvious improvement of swallow function and the efficacy of two types of stents were well established in the treatment of refractory benign esophageal stricture(z=-5.531, P=0.000). The technical successful rates were 100.0% in both group A and group B. It was not significantly different in the grade of swallow function between two groups after stenting (P=0.107). The rate of stent dislocation was 82.6%(19/23) in group A and 6.3%(1/16) in group B, and the difference was statisticaly significant (P=0.000). Although the recurrent rate of stricture was not significantly different (P=1.000) between groups A (34.6%) and groups B (31.3%), the causes of recurrent stricture were different. Conclusions Stenting is an effective and safe alternative of conventional operation in the treatment of refractory benign esophageal stricture in some degree. Non self expandable stents are obviously better than SEMS on efficacy and long term results.