上消化道恶性梗阻内支架置入术后的常见并发症及处理

Common complications and treatments in the malignant obstruction of upper alimentary tract with stent insertion

目的 探讨上消化道恶性梗阻内支架植入术后常见并发症及处理方法。方法 12例上消化道狭窄或梗阻患者中 ,食管狭窄 9例 ,胃、十二指肠梗阻 3例。在X线监视下共放置支架 14枚 ,带膜支架 9枚 ,不带膜支架 5枚。结果 12例患者所有支架均一次安放成功 ,但术后发生的并发症有 :食物嵌顿 3例 ,胸骨后及上腹部痛 4例 ,肿瘤组织或肉芽组织向腔内生长、再狭窄 3例 ,支架滑脱或移位 3例 ,大量出血 (30 0ml以上 ) 2例。结论 内支架置入的确是解决上消化道梗阻的有效方法 ,但术后并发症较多 ,本组病例中发生率亦较高 ,提醒我们要在操作上精确到位 ,并积极对症处理 ,才能降低并发症的发生。

Objective To explore the common complications and methods of treatment in the malignant obstruction of upper alimentary tract with stent insertion. Methods With interventional procedure under fluoroscopic guidance fourteen self expanding stents were implanted in twelve patients, including nine with strictures or obstructions of esophagus, three with obstructions of gastroduodenum. Of the fourteen, nine were coated stents and five were uncoated stents. Results All stents were implanted successfully, but complications after the procedure occurred sometimes. There complications included: 1. Food bolus obstructed in three patients. 2. Chest pain occurred in four patients. 3. Tumour overgrowth or hyperplasia of granulation tissue in three patients caused restenosis of gastrointestinal tract. 4. Stent replacement in three patients. 5. Hemorrhage occurred in two patients (over 300 ml) causing threat to life. Conclusions The implantation of self expanding stent is a simple and effective method offering good palliation for upper alimentary tract obstructions. The complications shoud be treated correctly.