食管内照射支架治疗食管癌21例临床分析

目的分析125I食管内照射支架治疗中晚期食管癌的临床治疗效果。方法将42例食管癌患者平均分为观察组和对照组各21例,观察组放置125I食管内照射支架治疗,对照组放置普通支架,术后随访治疗效果及并发症。结果两组患者术后吞咽困难症状明显改善,未出现穿孔、出血、移位等并发症。观察组平均生存期390d,明显高于对照组平均生存期130d（P〈0.05）。结论 125I食管内照射支架治疗中晚期食管癌疗效优于普通支架,可明显延长患者生存期,值得临床推广。     

放射性125I粒子支架置入治疗中晚期食管癌的临床研究(附6例报告)

目的:观察放射性粒子支架临床使用的可行性、安全性及初步疗效.材料与方法:根据患者具体病变情况和巴黎系统原则设计、订做放射性粒子支架,支架均为附带125I粒子的机织捆式支架.采用透视监视下经口腔置入法,所有食管癌患者术后均进行临床观察随访.结果:共治疗6例食管癌患者,其手术顺利,支架置入准确.随访中,2例术后3个月复查胸部CT示肿瘤缩小;1例术后6个月时出现食管-气管瘘,因感染死亡;2例分别于术后2个月和3个月时出现上消化道大出血死亡;1例6个月后死亡;2例正在随访中.结论:放射性粒子支架置入是食管癌内照射治疗的一种可行而有效的新方法,然仍需进一步完善,并加强并发症的预防和副反应的处理.     

125I支架对术后复发食管与贲门癌的疗效观察

目的 探讨附有125I粒子的自膨式金属支架对术后复发食管癌与贲门癌患者的疗效.方法 回顾分析2008年4月～2009年4月该科28例术后复发食管癌与贲门癌不愿和(或)不能再次手术患者(食管癌复发19例,贲门癌复发9例),在DSA监视下置入附有125I粒子的自膨式金属食管支架.结果 28例患者支架全部顺利置放,支架置入成功率100%,随访18个月,支架置入后所有患者吞咽困难症状均有改善,明显提高惠者生活质量及生存期,且无严重并发症发生.结论 附有125I粒子的自膨式金属支架对术后复发食管癌与贲门癌治疗效果明显,操作简单、安全,且无与支架置入相关的严重并发症,值得临床推广.     

放射性^125Ⅰ粒子支架置入治疗中晚期食管癌的临床研究（附6例报告）

目的：观察放射性粒子支架临床使用的可行性、安全性及初步疗效。材料与方法：根据患者具体病变情况和巴黎系统原则设计、订做放射性粒子支架，支架均为附带^125Ⅰ粒子的机织捆式支架，采用透视监视下经口腔置入法，所有食管癌患者术后均进行临床观察随访。结果：共治疗6例食管癌患者，其手术顺利，支架置入准确。随访中，2例术后3个月复查胸部CT示肿瘤缩小；1例术后6个月时出现食管一气管瘘，因感染死亡；2例分别于术后2个月和3个月时出现上消化道大出血死亡；1例6个月后死亡；2例正在随访中。结论：放射性粒子支架置入是食管癌内照射治疗的一种可行而有效的新方法，然仍需进一步完善，并加强并发症的预防和副反应的处理。．     

碘-125粒子捆绑支架治疗食道癌的临床研究

目的对中晚期食管癌采用I^125粒子源植入治疗的方法和价值进行探讨。方法将装有I^125粒子源的硅胶管捆绑在食管支架的表面根据肿瘤组织的分布情况进行布阵。在透视下将支架植入食管。结果11例患者共使用224粒I^125。粒子源3个月随访,无血象改变,气管食管瘘发生。结论附有I^125粒子的自膨式食管支架能明显缓解吞咽困难症状,能进行组织内照射,明显提高患者生活质量及生存期,切无严重并发症发生。     

食管癌I~(125)粒子支架植入术护理体会

[目的]分析内镜下I125粒子支架治疗晚期食管癌的护理措施及要点。[方法]对32例晚期食管癌病人在内镜下行I125粒子支架植入,并给充分的术前、术中、术后护理。[结果]32例病人除1例发生食管穿孔家属放弃治疗外,其余病人均恢复良好,吞咽困难明显改善,术后能进食普食或软食。随访3个月,无大出血、支架移位、脱落等并发症。[结论]内镜下I125粒子支架植入是治疗晚期食管癌的有效方法,良好的术前术后护理及术中配合对治疗效果起重要作用。     

碘-125粒子支架治疗不同病理类型晚期食管癌的疗效观察

目的探讨附有碘-125粒子的自膨式金属支架对不同病理类型的晚期食管癌患者的疗效。方法 65例晚期食管癌(均为Ⅲ、Ⅳ期)患者按病理类型不同分为A、B两组。A组41例为鳞癌,B组24例为腺癌。均在DSA监视下置入附有碘-125粒子的自膨式金属食管支架。术后随访观察支架置入成功率、并发症发生率及生存期。结果 65例均成功置入附有碘-125的粒子支架,支架置入后所有患者吞咽困难症状均有改善。无与支架置入术有关的严重并发症发生。其中A组平均生存期11.7个月,B组平均生存期9.6个月。两者比较差异有显著性(t=-3.175,P0.05)。两组均未出现严重并发症。结论附有碘-125粒子的自膨式食管金属支架能明显缓解吞咽困难症状,明显提高患者生活质量及生存期,且无严重并发症发生。对不同病理类型晚期食管癌疗效方面有所不同,据该院目前统计观察,鳞癌优于腺癌。     

植入粒子支架与普通支架治疗复杂性食管狭窄的研究

目的探讨植入粒子支架与普通支架治疗复杂性食管狭窄的临床疗效。方法选择2014年11月至2016年11月我院128例复杂性食管癌性狭窄患者,按随机数字表法分组,64例行125I粒子支架植入术治疗者为碘粒子组,64例行普通自膨支架植入术治疗者为对照组,随访6个月,比较两组疗效。结果术后第3d食管造影结果显示,支架植入成功率均为100%;术后,两组吞咽困难评分降低(P0.05),碘离子组术后6个月评分显著低于对照组,差异有统计学意义(P0.05);术后6个月,两组食管病变长度显著降低,KPS评分显著升高,且碘粒子组变化水平大于对照组,差异有统计学意义(P0.05);白细胞水平组间、组内比较,差异均无统计学意义(P0.05);两组食管再狭窄率差异有统计学意义(P0.05)。结论125I粒子支架植入术治疗复杂性食管癌性狭窄,近期疗效显著,可明显改善患者症状,降低术后食管再狭窄发生率,安全可靠,值得推荐。     

碘125粒子覆膜支架在中晚期食管癌中的应用价值

<正>食管癌死亡率位居全球肿瘤死亡率的第6位,大多数中晚期食管患者伴有食管狭窄、吞咽困难等问题,影响机体营养吸收,极易出现贫血、低蛋白血症、电解质紊乱等并发症[1]。食管覆膜支架置入可起到支撑食管的作用,使食物顺利通过,有效减轻患者营养不良等问题[2]。碘125粒子(125I)是一种具有确切疗效的低能放射粒子,广泛应用于术中植入治疗恶性肿瘤[3-4]。本研究将125I与食管覆膜支架联合应用,制作成内照射支架,植     

CT导向下125I粒子植入治疗肾上腺恶性肿瘤的护理

目的 探讨CT导向下125I粒子植入治疗肾上腺恶性肿瘤的护理要点.方法 回顾性分析2008年8月至2010年7月在CT导向下125I粒子植入治疗的15例肾上腺恶性肿瘤患者的临床护理资料.结果 患者全部按术前制订的治疗计划成功植入放射性粒子.术中有3例患者出现血压升高,2例患者CT扫描示病灶区有少量出血,术后5例患者出现疼痛,经处理后均得到缓解.术后全组随访4～24个月,经影像学检查,病灶完全消失7例,部分残留5例,病灶进展3例.结论 CT导向下125I粒子植入治疗肾上腺恶性肿瘤在护理上有其特殊要求,护理人员需要充分做好术前、术中及术后的各项护理工作,确保该项手术的疗效.     

捆绑125Ⅰ内照射粒子食管支架治疗食管鳞状细胞癌的临床疗效

目的探讨捆绑125Ⅰ内照射粒子食管支架治疗食管癌(ESCC)的临床疗效。方法将接受治疗的ESCC患者120例,随机分为实验组和对照组,各60例。实验组植入捆绑125Ⅰ内照射粒子的支架,对照组植入普通支架,观察比较其疗效、并发症及5年生存率。结果 120例患者均顺利植入支架,位置恰当,吞咽困难症状明显缓解,随访未发现出血、穿孔并发症,生活质量均得到提高,实验组5年生存率为23.7%,对照组5年生存率为11.6%,实验组明显高于对照组(P<0.05),两组术后体重及白细胞水平差异无显著性(P>0.05)。结论捆绑125Ⅰ内照射粒子食管支架可显著改善ESCC患者的吞咽困难症状,并对肿瘤进行组织间放疗,提高患者的生活质量,明显提高5年生存率,其疗效明显优于普通支架,且可靠性高。     

内镜下覆膜可回收食管支架与扩张器治疗食管吻合口良性狭窄的疗效与安全性比较

背景：随着食管支架工艺技术的不断进步,可回收食管支架治疗食管术后吻合口良性狭窄的疗法快速发展。目的：比较传统扩张器扩张疗法与放置覆膜可回收食管支架疗法治疗食管术后吻合口良性狭窄的疗效、生物相容性和安全性。方法：纳入54例食管术后吻合口狭窄患者按照自愿原则分为扩张器组和支架组,支架组置入MTN-SE-G-18/60和MTN-SE-G-20/60两种不同型号的镍钛记忆合金支架,便于不同吻合口直径患者的选择;扩张组置入硅胶扩张器。随访观察治疗后1,3,6个月吻合口大小、吞咽困难变化及并发症发生等情况。结果与结论：扩张组因需要反复扩张,咽喉部疼痛及局部渗血的发生率明显高于支架组,且有1例发生食管穿孔。两组患者治疗后1,3,6个月时吻合口的直径均逐渐减小,但较治疗前明显增大。支架组患者治疗后吻合口扩张及吞咽困难改善情况均优于扩张组,6个月时吻合口直径分别为0.94cm和0.63cm（P〈0.01）,能正常进食的比例分别为88%和48%（P=0.005）。提示,相对于扩张器治疗食管术后吻合口狭窄,镜下置入镍钛记忆合金全覆膜可回收食管支架的方法操作简便,并发症少且短暂,安全性高,患者痛苦小,易接受,远期疗效优。     

Management of malignant strictures of the cervical esophagus with a newly-designed self-expanding metal stent

Recently, the use of self-expanding metal stents has become a well-established method of palliative treatment for stenotic malignant diseases in the middle and distal esophagus. However, published results on the use of self-expanding metal stents in cervical esophageal cancer are somewhat limited by a paucity of clinical details and experience. A new self-expanding esophageal metal stent with a short upper flange 0.7 cm in length was studied prospectively in order to assess its efficacy for palliative treatment. This report presents experience in three patients in whom this new stent was used in the treatment of cervical esophageal cancers. Stent placement was successful in all three patients, with no serious complications such as esophageal perforation, hemorrhage, or foreign-body sensation. All of the patients experienced rapid improvement in dysphagia and clinical symptoms. The newly designed self-expanding stent can be of value in the treatment of stenotic cervical esophageal cancer.     

Management of malignant stricture of the esophagogastric junction with a newly designed self-expanding metal stent with an antireflux mechanism

BACKGROUND AND STUDY AIMS: When stents are placed across the esophagogastric junction for palliative treatment of malignant strictures, they may lead to esophagogastric reflux. The aim of this study was to compare the effectiveness of a newly designed antireflux stent with that of a standard open stent and a currently available antireflux stent (Dostent) in preventing gastroesophageal reflux symptoms in patients with inoperable cancer at the esophagogastric junction. PATIENTS AND METHODS: Thirty-six consecutive patients with cancer at the esophagogastric junction were randomly assigned to undergo placement of a newly designed antireflux stent (n = 12), a Dostent (n = 12), or a standard open stent (n = 12). Technical and clinical success, dysphagia score, reflux symptoms, complications and ambulatory 24-h esophageal pH monitoring were assessed. RESULTS: The technical success rates were 100 %. After 1 week, dysphagia had improved in all patient groups ( P < 0.05), but the degree of improvement did not differ between the three groups. The DeMeester score was significantly lower in the group with the newly designed antireflux stent than in the other groups. The fraction of the total recording time during which esophageal pH was below 4 was 3.14 +/- 5.78 % using the newly designed antireflux stent, in comparison with 29.25 +/- 15.41 % in the Dostent group and 15.01 +/- 11.72 % in the standard open stent group ( P < 0.001). Fewer reflux episodes occurred with the newly designed antireflux stent than with the Dostent or standard open stent. There were no complications with any of the three stents. CONCLUSIONS: The newly designed antireflux stent is effective in relieving dysphagia caused by malignant cancer at the esophagogastric junction. The newly designed antireflux stent is significantly more effective in preventing gastroesophageal reflux than currently available antireflux stents.     

覆膜食管支架在食管穿孔40例的应用分析*

目的探讨全覆膜食管支架治疗食管穿孔的效果和安全性。方法采用全覆膜金属支架治疗医源性、肿瘤及异物所致食管穿孔40例,观察对其的治疗效果及并发症。结果所有的食管穿孔患者一次性成功置入食管支架,术后均能顺利恢复进食;食管异物临时支架植入术后4天~1个月取出支架,复查胃镜及食管造影均明确穿孔愈合;3例食管癌并穿孔患者术后吞咽梗阻感明显缓解。主要并发症为术后胸痛及支架移位,6例(15%)出现支架移位,2例(5%)食管癌患者出现食物梗阻并支架移位。结论全覆膜金属支架治疗食管穿孔,具有疗效确切,并发症少,安全有效等优点。     

Tracheobronchial stenting in patients with esophageal cancer involving the central airways.

BACKGROUND AND STUDY AIMS: Locoregional progression of esophageal cancer can result in respiratory distress aving to tracheoesophageal (T-E) fistula or central airways stenosis. We report our experience of airway stenting in 51 patients with esophageal carcinoma involving the central airways. PATIENTS AND METHODS: All data were recorded retrospectively. Fifty-one patients (44 men and seven women), with a mean age of 58.6 years, were analyzed. All had an esophageal squamous cell carcinoma. Severe respiratory impairment due to tumor invasion or to a tracheobronchial fistula (n= 14) was present in all patients. Nine of the 14 patients with fistula had dysphagia. Among the 37 patients without fistula, 19 had dysphagia. RESULTS: Sixty-six tracheobronchial stents were inserted in 51 patients: 65 Dumon stents and one Wallstent. Forty stents were implanted in the trachea, 16 in the left main bronchus and 10 in the right main bronchus. In 47 patients there was a significant improvement of respiratory symptoms. Esophageal intubation, carried out in nine patients, allowed eating and drinking in all cases. Mean survival was 107.7 days, with the longest follow-up 587 days. There was no difference between mean survival in the patients with fistulae (103.3+/-days) and the others (109.3+/-days). In two cases stent placement was responsible for death (massive hemoptysis and pneumonia). The main complications were migration (n=6), granuloma (n=2), pneumonia (n=2) and pneumothorax (n = 2). In 13 patients tumor progression in the airways was noted from one to 11 months after stenting, inducing a relapse of dyspnea. CONCLUSIONS: Complications are easily detected by the appearance of respiratory symptoms and do not necessitate systematic flexible bronchoscopy, but only preventive measures such as regular aerosol therapy, adapted respiratory physiotherapy and regular clinical follow-up.     

食管支架置入术后并发症的分析与处理

目的探讨食管支架在中晚期食管癌伴严重进食梗阻患者中的应用价值与支架置入术后并发症的防治。方法在X线透视引导下,对16例食管癌患者进行食管支架置入术。结果所有患者一次性置入成功,梗阻症状明显改善。其中13例患者术后2周内出现不同程度的胸骨后疼痛;12例出现进食流质时吞咽困难和反流性食管炎的症状;未出现严重并发症。结论食管支架置入术可以有效缓解中晚期食管癌患者的进食梗阻症状,且具有创伤小、术后恢复快、并发症少等优点,值得临床推荐和应用。     

Effectiveness of esophageal dilation in relieving nonobstructive esophageal dysphagia and improving quality of life

OBJECTIVES: The role of empiric esophageal dilation in improving esophageal dysphagia with nonobstructive esophageal lumen is not clear. We wished to determine the impact of esophageal dilation with a large-diameter dilator on dysphagia and quality of life in such patients. We also assessed relative prevalence of esophageal versus oropharyngeal dysphagia and nonobstructive versus obstructive esophageal dysphagia in ambulatory patients. METHODS: Ambulatory patients presenting with swallowing complaints were evaluated by history and physical examination, speech therapy evaluation, dynamic barium oropharyngeal swallowing study, and barium esophagram plus upper endoscopy. Patients diagnosed as having nonobstructive esophageal dysphagia were offered participation in the study. Eligible candidates were randomized to either 56-French (the study group) or 40-French (the control group) Pilling dilators. All patients were treated with proton pump inhibitors. Patients completed questionnaires for dysphagia score, diet score, and quality of life (SF-36) at baseline, at 1 month, and then at follow-up visits at 1- to 3-month intervals for up to 12 months. RESULTS: Of the 125 patients complaining of swallowing difficulties, 6 (5%) were diagnosed as having oropharyngeal dysphagia and 119 (95%) had esophageal dysphagia. Of the patients with esophageal dysphagia, 84 (67%) had nonobstructive dysphagia. A total of 30 patients participated in the study. Seventeen patients were randomized to the study group and 13 were randomized to the control group. The baseline dysphagia, diet, and quality-of-life scores were comparable between groups. Dysphagia in both groups improved after dilation compared with baseline; however, the difference in the degree of improvement between the two groups was not significant. In addition, there was no significant difference in improvement of the quality of life between the two groups. CONCLUSION: Most patients with esophageal dysphagia have a nonobstructing esophageal lumen. Our prospective, randomized, controlled study does not support the practice of empiric esophageal dilation for patients with nonobstructive esophageal dysphagia. Improvement in both groups suggests the possibility that it occurred due to proton pump inhibitor therapy, lending credence to the hypothesis that esophageal hypersensitivity to acid contributes to symptoms in most patients with nonobstructive esophageal dysphagia, which is the predominant category of dysphagia.     

Palliation of esophageal carcinoma with a new self-expanding plastic stent

BACKGROUND AND STUDY AIMS: Self-expandable metallic covered stents (SEMS) are widely used for the palliation of esophageal cancer. In the long term, a drawback of these stents is the occurrence of nontumoral occlusion at their proximal or distal parts. New self-expanding plastic stents (SEPS) may combine the advantages of SEMS with those of previously used plastic stents. Our aim was to study prospectively the implantation of such stents in a series of patients with fairly long life expectancy, focusing on safety, feasibility and long-term effectiveness. PATIENTS AND METHODS: Between June 1999 and December 2000, in a prospective cohort study, 33 patients were treated with Polyflex stents for palliation of esophageal stenoses, and were followed up until death. The inclusion criteria demanded the presence of a nonresectable or nonoperable, histologically proven, malignant stricture of the esophagus causing significant dysphagia. RESULTS: Stent insertion was successful in all cases. The mean duration of follow-up of the patients was 149.7 days (range 25 - 469). A complete follow-up until death was documented for all patients (n = 33). During the entire follow-up, no stent occlusion was observed which was caused by either nontumoral or tumoral ingrowth, or by nontumoral overgrowth. Stent occlusions were caused only by tumoral overgrowth, and occurred at a rate of 12.1 % (n = 4). The stent migration rate was 6.0 % (n = 2), and the re-intervention rate overall was 21.1 % (n = 7). CONCLUSIONS: These results show that SEPS are effective for the palliation of dysphagia in patients with esophageal malignancies. The immediate results are similar to those observed with SEMS, and the observed low rate of late obstruction suggests that their long-term efficacy might be superior to that of SEMS. This device warrants evaluation in a controlled prospective trial.