内镜下覆膜食管支架治疗食管癌性狭窄及食管气管瘘的临床应用价值

The value of clinical application of covered esophageal stent in the treatment of malignant esophageal stenosis and esophago-tracheal fistula under endoscope

目的探讨内镜下覆膜食管支架治疗食管癌性狭窄及食管气管瘘的临床价值及食管支架置入术并发症的防治。方法回顾性分析163例晚期食管癌患者内镜下覆膜食管支架治疗食管癌性狭窄及食管气管瘘的临床资料,其中7例患者为食管癌性狭窄并食管-支气管瘘伴双下肺感染,19例患者为食管癌术后复发吻合口狭窄置入镍钛记忆合金覆膜支架。102例患者由于食管过于狭窄先行食管扩张,再进行内镜下放置食管支架,35例患者直接内镜下置入食管支架。结果 163例患者先后放置174个支架,均一次性置入成功,成功率为100%。163例患者均有不同程度胸痛不适,有32例支架再狭窄,其中19例单纯行支架内球囊扩张,11例于原支架上端内部分重叠再放置一支架,有26例行氩气刀再通治疗。7例患者出现支架移位,有2例支架进入食管瘘管内于次日在内镜下取出支架重新放置。所有病例均未出现食管破裂、食管血肿或出血等严重并发症,术后患者进食能力提高,食管气管瘘闭合。结论内镜下覆膜食管支架置入术是中晚期食管癌性狭窄简单、安全、有效的姑息治疗方法,能提高患者的生活质量,延长患者的生存期。

Objective To investigate the clinical value of coated esophageal stent in the treatment of ma-lignant esophageal stenosis and esophago-tracheal fistula and its related complications. Method A retrospec-tive analysis was made from 163 advanced esophageal cancer patients who were treated using covered esophageal stent in order to deal with the esophageal stenosis and esophago-tracheal fistula. Among them, 7 patients for esophageal stenosis and esophageal and esophago-tracheal fistula with double lung infection, 19 patients for anastomotic stenosis due to postoperative recurrence of esophageal cancer. Results One hundred and seventy four stents were implanted successfully in 163 patients, the success rate was 100%. After stent im-plantation, all patients had chest discomfort in various degrees. Restenosis occurred in 32 patients, including 19 patients underwent stent balloon dilatation, 11 patients implanted stent again in the upper end of the bracket in manner of partially overlapped, and 26 patients underwent argon knife reperfusion therapy. Stent migration oc-curred in 7 patients. No serious complications such, as rupture of the esophagus, esophageal hematoma or hemorrhage were observed. Eating capacity was improved and esophago-tracheal fistula closure was observed after operation. Conclusion Endoscopic covered esophageal stent placement for advanced esophageal stenosis is a simple, safe, and effective palliative treatment which can improve the patient′s quality of life and prolong survival time of the patients.