国产不同类型食管内支架的临床应用

Analysis of Clinical Application for Various Types of Esophageal Stents Made in China

背景与目的:食管癌患者临床表现以吞咽困难为主。食管支架置入术是解决患者吞咽困难的一种有效方法。食管内支架种类较多,本研究通过对国产“Z”型食管内支架与镍钛合金网状编织型支架及被覆支架与非被覆支架的对比观察,探讨不同类型食管内支架在治疗食管恶性狭窄中的临床应用价值。方法:给40例食管癌患者置入不同类型食管内支架,其中“Z”型不锈钢支架13例,镍钛合金网状编织型支架27例;被覆支架24例,非被覆支架16例。支架置入前均未用球囊扩张。结果:40例食管支架均一次性成功置入,无并发症。“Z”型不锈钢支架术中即刻张开,术后均有明显胸痛,持续10～20天。镍钛合金网状编织型支架术中虽未能完全张开,术后1～3天可逐渐张开,术后9例有胸痛,持续3～5天,其中采用被覆支架者7例,采用非被覆支架者2例。9例伴有食管气管瘘者瘘口封堵完全。无食管气管瘘者置入的被覆支架与扩张的食管壁之间有钡剂潴留。结论:镍钛合金网状编织型支架的临床适应性优于“Z”型不锈钢支架,对于合并食管气管瘘的患者应选用被覆支架,对于无合并食管气管瘘的患者,非被覆支架优于被覆支架。支架置入术前可不必球囊扩张。

BACKGROUND &OBJECTIVE: Dysphagia is the main clinical symptom of the patients with esophageal carcinoma. The stent placement in esophagus is an effective method to resolve dysphagia.There are many types of stents. Through comparing observation of the stents made in China, which is the stainless steel 'Z'stent, the Ni Ti wire mesh like stent, and the covered or uncovered stent, the authors analyzed the clinical application of various types of esophageal stents in the treatment of malignant esophageal stricture. METHODS: The various types of esophageal stents were implanted into 40 patients with esophageal carcinoma. 13 cases for stainless steel 'Z' stents, 27 cases for Ni Ti wire mesh like stents(24 cases were the covered stents and 16 cases were uncovered). All the patients were not operated with the dilation of balloon before stent placement. RESULTS: The esophageal stents were successfully implanted into 40 patients without complication of operation. Stainless steel 'Z'stent were all dilated immediately at the time of operation, and all the 13 patients had obvious intra breastbone pain after operation, which lasted 10 20 days. Although Ni Ti wire mesh like stents could not dilate completely in operation, all these can be dilated completely after 1 to 3 days; nine cases of them had obvious intra breastbone pain, which lasted 3-5 days. In all these, 7 cases were the covered stents and 2 cases uncovered. In 9 cases, tracheoesophageal fistulas were blocked completely. There was barium sulphate retention between the covered stent implanted to the patients without tracheoesophageal fistula and the dilated esophagus. CONCLUSION: The clinical adaptability of the Ni Ti wire mesh like stent is better than that of the stainless steel 'Z'stent. For the patients with tracheoesophageal fistula, the first choice is covered stent, while for the patients without tracheoesophageal fistula, uncovered stent is better. The dilation of balloon is not necessary before the stent placement.