食管金属支架治疗125例食管狭窄和食管气管瘘临床分析

Esophageal Metallic Stent in the Treatment of Esophageal Stenosis and Esophago-tracheal Fistula: A Clinical Analysis of 125 Cases

背景:食管狭窄和食管气管瘘是临床常见疾病,近年来食管金属支架逐渐成为其治疗的重要手段,并取得了良好的疗效。目的:探讨食管金属支架治疗食管狭窄和食管气管瘘的临床疗效。方法:选择125例良恶性食管狭窄和食管气管瘘患者,行内镜和X线检查以明确狭窄或瘘口的部位和性质。在X线引导下置入食管金属支架,术后密切随访观察临床疗效和并发症。结果:支架术后2周内,所有患者的吞咽困难均显著改善;食管气管瘘患者的呛咳均显著缓解,仅5例患者进流质时仍有轻微呛咳;86例(68.8%)患者术后出现胸痛,8例(6.4%)发生消化道出血,4例(3.2％)出现支架移位。术后平均随访时间为18个月。吞咽困难的平均缓解时间为7.4个月,27例恶性食管狭窄患者平均于术后6.4个月因肿瘤组织增生而导致再狭窄,8例良性食管狭窄患者平均于术后12.8个月因肉芽组织增生而导致再狭窄。38例患者有胃(或肠)食管反流表现,大多为吻合口支架或食管下段支架。7例患者出现支架移位。恶性食管狭窄患者支架术后平均存活时间为11.8个月。结论:食管金属支架能有效治疗良恶性食管狭窄和食管气管瘘,提高患者的生活质量。但支架术后再狭窄、食管功能紊乱和支架移位等并发症目前仍无法避免,且可能对支架的临床应用产生一定影响。

Background: Esophageal stenosis and esophago-tracheal fistula are common clinical diseases. Recently esophageal metallic stent has become the important treatment method for these disorders with good efficacy. Aims: To appraise the clinical efficacy of esophageal metallic stent in the treatment of esophageal stenosis and esophago-tracheal fistula. Methods: One hundred and twenty-five patients with benign and malignant esophageal stenosis and esophago-tracheal fistula were enrolled. The sites and characteristic of the stenosis or fistula were verified by endoscopy and X-ray. The esophageal metallic stent was placed under the guidance of X-ray, and the clinical effectiveness as well as complications were closely observed during follow-up after stenting. Results: Within the postoperative 2 weeks, the dysphagia was much improved in all patients; The choking and coughing were greatly relieved in all patients with esophago-tracheal fistula, only 5 patients had little coughing while drinking liquid; Eighty-six patients (68.8%) had chest pain after stenting, 8 (6.4%) gastrointestinal hemorrhage, and 4 (3.2%) stent displacement. The average follow-up period after stenting was 18 months. The average duration of remission of dysphagia was 7.4 months. Restenosis occurred in 27 patients with malignant esophageal stenosis 6.4 months after stenting because of hyperplasia of tumorous tissues; 8 patients with benign esophageal stenosis had restenosis 12.8 months after stenting, due to hyperplastic granulation tissues. Thirty-eight patients had gastro- or duodenal-esophageal reflux, most of them had stents situated at the anastomotic stoma or lower esophagus. Seven patients had stent displacement. The average survival period of patients with malignant esophageal stenosis was 11.8 months after stenting. Conclusions: The benign and malignant esophageal stenosis, and esophago-tracheal fistula can be treated with esophageal metallic stent effectively, and the patients' quality of life is much improved. But complications as restenosis, disordered esophageal function and stent displacement are unavoidable and may influence the clinical use of stenting.