DZAS-Ⅰ型覆膜支架置入术治疗难治性食管癌术后吻合口狭窄的临床效果分析

Analysis of the clinical effect of DZAS-Ⅰcovered stent implantation in the treatment of refractory anastomotic stenosis after operation for esophageal cancer

目的分析DZAS-Ⅰ型覆膜支架置入术治疗难治性食管癌术后吻合口狭窄的临床效果。方法选择2014年6月至2019年6月西南医科大学附属成都三六三医院收治的80例难治性食管癌术后吻合口狭窄患者为研究对象,采用随机数字表法将其分为覆膜支架组和合金支架组,每组各40例。两组患者均行内镜下切开术治疗,分别留置DZAS-Ⅰ型覆膜支架和镍钛合金支架。比较两组患者治疗安全性、支架可靠性、支架安全性、吻合口狭窄和吞咽困难恢复情况。结果覆膜支架组患者术后并发症发生率显著低于合金支架组(P<0.05),支架完全可靠率和支架完全有效率均显著高于合金支架组(均P<0.05)。两组患者治疗后吻合口直径均显著大于本组治疗前(均P<0.05),吞咽困难评分均显著低于本组治疗前(均P<0.05)。治疗后2个月、4个月,两组患者吻合口直径均显著小于本组治疗后1个月(均P<0.05),吞咽困难评分均显著高于本组治疗后1个月(均P<0.05),且覆膜支架组患者吻合口直径均显著大于同期合金支架组(均P<0.05),吞咽困难评分均显著低于同期合金支架组(均P<0.05)。结论对于难治性食管癌术后吻合狭窄患者,DZAS-Ⅰ型覆膜支架的安全性较传统合金支架更为理想,其在支架置入可靠性、有效性方面亦具有显著优势,对于缓解吻合口狭窄、改善吞咽困难症状的作用更为显著,值得临床推广应用。

Objective To analyze the clinical effect of DZAS-Ⅰcovered stent placement in the treatment of refractory anastomotic stenosis after operation for esophageal cancer.Method From June 2014 to June 2019,80 patients with refractory anastomotic stenosis after operation for esophageal cancer in Chengdu 363 Hospital Affiliated to Southwest Medical University were randomly divided into covered stent group and alloy stent group,with 40 cases in each group.All patients were treated by endoscopic incision,and DZAS-Ⅰcovered stent and nitinol stent were retained respectively.The treatment safety,stent reliability,stent safety,anastomotic stenosis and dysphagia recovery were compared between the two groups.Result The incidence of postoperative complications in covered stent group was significantly lower than that of alloy stent group(P<0.05),and the complete reliability rate and the complete effective rate of the stent were significantly higher than those in alloy stent group(all P<0.05).After treatment,the diameter of anastomotic stoma in both groups were significantly larger than that before treatment(all P<0.05),and the dysphagia scores were significantly lower than that before treatment(all P<0.05).2 and 4 months after treatment,the diameter of anastomotic stoma were significantly smaller than those 1 month after treatment in both groups(all P<0.05),and dysphagia scores were significantly higher than those 1 month after treatment in both groups(all P<0.05),the diameter of anastomotic stoma in covered stent group were significantly larger than those in alloy stent group(all P<0.05),and dysphagia score were significantly lower than those in alloy stent group(all P<0.05).Conclusion For patients with refractory anastomotic stenosis after operation for esophageal cancer,the safety of DZAS-Ⅰcovered stent is more ideal than traditional alloy stent,it has significant advantages in reliability and effectiveness of stent placement,which is more significant in relieving anastomotic stenosis and dysphagia symptoms,and is worthy of clinical promotion and application.