食管支架治疗难治性食管癌术后颈部吻合口狭窄

Stent Placement in Patients with Refractory Cervical Anastomotic Strictures Following Esophagectomy

目的:探索难治性食管癌术后颈部吻合口狭窄的治疗方法,评价食管支架置入术对其的疗效。方法:应用自制塑料食管支架10个、Celestin管8个及自扩金属支架14个共32个食管支架治疗难治性颈部吻合口狭窄患者25例,其中合并吻合口瘘5例。吻合口狭窄0.00～0.60cm,平均0.26±0.13cm(95%可信限0.23～0.29cm)。食管支架置入术前吞咽功能分级平均2.56±0.58级。无合并吻合口瘘者在支架置入术前2月内已行食管扩张术2～5次无效或效差,合并吻合口瘘者在支架置入术前未行食管扩张术治疗。结果:支架置入术成功率100%。随访时间4.0～36.0月,平均13.48±8.55月。全组支架置入术后吞咽功能分级平均为0.32±0.48级,平均提高2.24±0.78级,吞咽功能明显改善(t=14.378,P=0.000);吻合口瘘口全部被阻断、愈合。15例初次置入的支架脱落,脱落时间平均2.95±1.98月,其中14例为管型支架,1例为不带膜金属支架,5例发生再狭窄;10例未脱落,其中金属支架7例、管型支架3例。8例局部疼痛,4例出现明显胃食管反流,2例出现支架腔内粘膜生长引起再狭窄。结论:食管支架治疗难治性食管癌术后颈部吻合口狭窄方法简单,疗效确切;选择支架时,应首选塑料支架或Ce-lestin管,放置金属自扩支架要慎重。

Objective: To seek an effective method and to evaluate the efficacy of stent placement in the patients with refractory cervical anastomotic strictures following esophagectomy. Methods: Twenty five patients with inextricable cervical anastomotic strictures following esophagectomy were treated with 32 esophageal stents. Of them, 5 cases were complicated with anastomotic leakage. The diameter of the structures was from 0.00 to 0.60 cm, the average was 0.26±0.13cm(95%CI as 0.23-0.29 cm). The grade of swallow function in this series before intubation was 2.56±0.58.The stents included 10 self made prostheses, 8 Celestin tubes (Wilson Cook, USA), and 14 self expandable metallic stents. Twenty patients who did not complicate with anastomotic leakage failed to response to dilation from 2 to 5 times during 2 months. The others had not been undergone dilation. Results: The technical successful rate was 100%. The follow up time was from 4.0 to 36.0 months. The grade of swallow function increased significantly from 2.56±0.58 before intubation to 0.32±0.48 after intubation (t=14.378, P=0.000). The anastomotic leakages were blocked immediately and healed quickly. Fifteen stents that were placed first dislocated in 2.95±1.98 months in which 14 were tubular prostheses, 1 was uncovered self expandable metallic stent. The other 10 stents did not dislocated in which 3 were tubular prostheses, 7 were uncovered self expandable metallic stents. In the follow up period, cervical pain appeared in 8 cases, gastroesophageal reflux obviously was found in 4 cases, tumor growth in 2 patients. Conclusion: Esophageal stent placement is a simple, effective way for patients with refractory cervical anastomotic strictures following esophagectomy; the self made prostheses or Celestin tube are better than the self expandable metallic stent for these patients.