带膜支架治疗高位食管疾病

Treatment of high-positioned esophageal diseases with membrane-covered self-expanding stents

目的 :探讨食管带膜支架治疗高位食管癌、食管 -气管瘘、吻合口狭窄的效果及支架置入的一些相关问题。方法 :采用内镜法、直接法为高位晚期食管癌、食管 -气管瘘、高位吻合口狭窄等患者 2 3例共置入 2 3个支架。结果 :疗效满意 ,明显改善了患者生活质量 ;1例支架置入后疼痛严重取出支架 ;3例支架置入位置有误经内镜成功调整 ;6例发生咽功能紊乱经治疗后 5例痊愈 ,l例取出支架。结论 :食管带膜支架置入术只要定位准确 ,不失是一种操作简单有效 ,安全可靠的方法 ,特别适于晚期食管癌的狭窄和食管 -气管瘘。吻合口狭窄的治疗不首选支架。支架置入后疼痛。

Objective:To evaluate therapeutic effect of membrane-covered self-expanding metallic stent on high-positioned advanced esophageal carcinoma,esophagotracheal fistula and anastomotic stricture,and relevant problems to stent implantation.Methods:23 membrane-covered self-expandable stents were implanted in 23 patients with high-positioned advanced esophageal carcinoma (12 cases),esophagotracheal fistula (6 cases) and high-positioned anastomotic stricture (5 cases).The implantation of the stents was performed under endoscope or perorally.Results:The severity of dysphagia was reduced,and life quality of the patients was improved significantly.One stent had to be taken out for severe pain. The positions of 3 stents were successfully adjusted by endoscope for improper position after the first implantation.6 patients suffered from the disorder of pharyngeal function after implantation,among which 5 were cured,and 1 had the stent taken out.Conclusion:Membrane-covered self-expanding metallic stent is effective,safe and easy to insert,especially for patients with the stricture of the high-positioned advanced esophageal carcinoma,and the esophagotracheal fistula.However stent is not the first choice for the treatment of anastomotic stricture.Post-implantation pain,improper position of stent and the disorder of pharyngeal function can be solved by active management.