改良型超覆膜分段食管支架在高位食管恶性狭窄中的疗效观察

Evaluation of improved covered metalfic stents for proximal malignant esophageal strictures

目的探讨改良型超覆膜分段式支架在食管高位恶性狭窄中的有效性和安全性。方法山西省肿瘤医院内镜室2013年2月至2014年8月期间，内镜下置入直径14mm或16mm改良型超覆膜分段支架治疗56例高位食管恶性狭窄，对比手术前后患者吞咽困难情况、体力状况和生活质量的改善，进行统计学分析。同时观察术中、术后不良反应和并发症的发生情况。结果56例患者均在扩张后成功置入支架，术中、术后无支架相关性的严重并发症。支架置入后患者吞咽困难迅速得以改善，其中显效45例，好转10例，1例因无法耐受支架，被迫取出，吞咽困难缓解率为98．2％（55／56）。术后2周患者吞咽困难分级（Stooler分级）较术前明显好转（t=7．05，P〈0．05），体力状况评分（ZPS评分）显著改善（t=22．49，P〈0．05），生活质量改善（Kamofsky评分）差异未见统计学意义（t=1．07，P〉0．05）；在90d的随访中未见出血及穿孔等严重并发症发生。结论改良型超覆膜分段食管支架在高位食管恶性狭窄的治疗中安全、有效。

Objective To explore the efficacy and safety of improved covered metallic stents for proximal malignant esophageal strictures. Methods A total of 56 patients with proximal malignant esopha- geal strictures were treated with improved covered metallic stents whose diameter was 14 mm or 16 mm at Shanxi Province Tumor Hospital from Feburary 2013 to August 2014. Swallowing condition, physical and life quality were compared before and after surgery and analyzed. At the same time, side effects and complica- tions were recorded during and after surgery. Results All 56 patients were treated successfully with im- proved covered metallic stents, no complications related with stents occurred after surgery. Swallowing condi- tions were improved after surgery, there were 45 patients with obvious improvement, 10 patients with better improvement and 1 patient＇s stent taken out due to stent intolerance. Remission rate of swallowing conditions was 98.2% （ 55/56 ）. Two weeks after surgery, Stooler of swallowing conditions obviously improved （ t = 7.05 ,P 〈0. 05）, physical conditions（ZPS） also improved（t =22.49, P 〈0. 05）, but there was no signifi- cant difference in life quality（ Kamofsky scores） （t = 1.07, P 〉 0. 05 ）. During 90 days of follow-up there was no hemorrhage or perforation. Conclusion The application of improved covered metallic stents for prox- imal malignant esophageal strictures is safe and effective.