食管良性狭窄金属内支架介入治疗随访研究

Metal stent dilation in the treatment of benign esophageal stricture by interventional procedure: a follow-up study

目的:对食管良性狭窄金属内支架介入治疗后进行随访 方法:75例食管良性狭窄患者,其中永久性金属支架扩张组(A组)25例;暂时性部分带膜金属支架扩张术组(B组)50例。在X线引导下,A组25例安放部分带膜金属支架15只,不带膜金属支架10只;B组50例安放部分带膜金属支架50只,在支架术后3～7d由胃镜取出。所有患者,治疗前食管管腔最窄处直径0.5～8.3mm,吞咽困难评分2～4级;治疗后食管管腔最窄处直径8.7～21.0mm,吞咽困难评分0～1级。所有患者术后随访6～54mo[平均(23.3±15.2)mo]不等。 结果:A组术后并发症发生率为疼痛40％(10/25)、反流60％(15/25)、出血12％(3/25)、支架移位16％(4/25);超过6mo的随访患者中20％(5/25)复发吞咽困难,超过1a的随访患者中25％(2/12)复发吞咽困难,超过3a的随访患者中60％(3/5)复发吞咽困难。B组术后并发症发生率为疼痛40％(20/50)、反流20％(10/50)、出血14％(7/50);超过6mo的随访患者中14％(7/50)复发吞咽困难,超过1a的随访患者中15％(6/40)复发吞咽困难,超过3a的随访患者中16％(4/25)复发吞咽困难。 结论:暂时性部分带膜金属支架扩张术是食管良性狭窄金属内支架介入治疗中远期疗效中首选方法。

AIM: To make a follow-up study of benign esophageal stricture treated with metal stent dilation by interventional procedure.METHODS: There were 75 cases of benign esophageal stricture with metal stent dilation by interventional procedure, in which 25 cases were with permanent (group A) and 50 cases with temporary (group B) placement of expandable metallic stent respectively. All cases were completed under fluoroscopy. 15 partial covered and 10 uncovered expandable metallic stents were temporarily placed in the group A. 50 partial covered expandable metallic stents were temporarily placed in the group B and drawn out within 3-7 days via gastroscopy.AII stents placement and drawing were technically successful. Diameters of the strictured esophagus were 0.5 - 8.3 mm before dilations and 8.7-21.0 mm after dilations. Dysphagia scores of all cases were from grade 2 to grade 4 before dilations and form grade 0 to grade 1 after dilations. Follow-up periods of all cases was from 6 months to 54 months [mean (23.3±15.2) months].RESULTS: Complications in 25 cases of group A were chest pain (n = 10), reflux ( n = 15), bleeding ( n = 3) and stent migration (n = 4). 5 (20 %) in 25 cases of group A were dysphagia relapse during follow-up over 6 months; 3 (25 %) in 12 cases, over 12 months; and 3 (60 %) in 5 cases, over 36 months. Complications in 50 cases of group B were chest pain (n = 20), reflux (n = 10) and bleeding (n = 7). 7 (14 %) in 50 cases of group B were dysphagia relapse during follow-up over 6 months, 6 (15% ) in 40 cases, over 12 months, and 4 (16 %) in 25 cases, over 36 months, respectively.CONCLUSION: Temporary placement of partial covered expandable metallic stent was the first treatment method of esophageal stenosis with interventional procedure in mid and long-term therapeutic efficiency.