颈段高位食管恶性梗阻的介入治疗

Interventional therapy of cervical esophageal malignant obstruction

目的 探讨介入微创技术在颈段高位食管恶性梗阻治疗中的可行性。方法 颈段高位食管梗阻病例39例,梗阻部位近端分别位于食管环咽段至以下12mm区间。经用扩张管进行耐受性扩张试验后,在X线影像监视下经口置入用单丝编制的网管状镍钛合金支架疏通食管腔,并经供血动脉介入化疗抑制肿瘤。结果 39例患者共放置46枚高位食管支架。支架放置后所有病例均能进食细渣饮食。除轻微疼痛和可耐受性不适外未产生其他不良反应。接受介入化疗患者的平均生存时间较单纯支架治疗患者长。结论 颈段高位食管恶性梗阻并非内支架治疗禁区,介入化疗对颈部恶性病变也能起到有效的抑瘤作用。

Objective To explore the feasibility of microinvasive technique in high level malignant esophageal obstruction and to provide the palliative therapy that can't be dredged by traditional methods. Methods There were 39 patients suffered from high level esophageal obstruction,involving the segments from esophageal circular pharynx to 12mm below. Tube-reticular nitinol metal stents woven by single thread were placed in orally to dredge the esophagus under fluoroscopic guidance after repeated tolerant expanding performance through expandable catheter. Interventional chemical therapy were administrated through blood-supply vessels. Results Thirty nine patients were grafted with 46 high level esophageal stents. 34 patients accepted 156 times of interventional chemical therapy. All patients restored with fine residue diet without showing side-effects except slight pain and tolerant uncomfortable feeling. The survival rate of the patients with both interventional chemical therapy and stents was longer than those with stent therapy alone. Conclusion Cervical high level segment of esophagus shouldn't be the restricted zone in the management of inner-stents. Interventional chemical therapy showed tumor-inhibiting effect in the cervical malignant diseases.