全覆膜食管金属支架治疗高位食管疾病

目的评价全覆膜食管金属支架在高位食管狭窄和瘘以及术后吻合口狭窄和瘘治疗中的有效性和安全性。方法复旦大学附属中山医院内镜中心2005年5月至2013年7月间，应用16mm全覆膜食管金属支架对84例高位食管狭窄和瘘以及术后吻合口狭窄和瘘进行治疗。其中食管癌性狭窄31例，食管外压性狭窄2例，食管癌放疗后狭窄10例，食管癌术后复发致狭窄4例，吻合口狭窄27例，内镜黏膜下剥离术后食管狭窄1例，食管．气管瘘7例，食管一纵隔瘘1例，食管癌术后残胃瘘1例。狭窄或瘘口上缘距中切牙距离15～20cm者48例，大于20cm者36例。结果84例患者共置入100枚支架，术中无出血和穿孔等并发症发生。支架置入术后患者吞咽困难、呛咳症状均迅速缓解。术后并发症发生率为6．0％（5／84），其中严重胸痛2例，经止痛药物缓解；气管塌陷1例，予气管切开术；支架移位2例，内镜下应用异物钳对支架位置进行调整。76例（90．5％）患者获得完整随访，5-3％（4／76）的患者出现再狭窄，2．6％（2／76）新发食管．气管瘘；其中5例接受再次内镜下置入全覆膜金属支架术并获成功，另1例经沙氏探条扩张及氩离子凝固术治疗效果满意。结论全覆膜食管金属支架治疗高位食管狭窄和瘘以及术后吻合口狭窄和瘘安全、有效，可考虑作为临床首选。

Membrane-covered self-expanding stents in the treatment of high-positioned esophageal stenosis or fistula

Objective To investigate the efficacy and safety of membrane-covered self- expanding metal stent in the treatment of high-positioned esophageal diseases, including esophageal stenosis, esophagotracheal fistula and anastomotic stricture. Methods Clinical data of 84 patients who underwent stenting in our center from May 2005 to July 2013 were retrospectively analyzed. Of 84 patients, 31 were diagnosed as esophageal malignant stenosis, 2 compression stenosis, 10 radiation stenosis, 4 recurrent malignant stenosis, 27 anastomotic stricture, 1 esophageal stenosis after endoscopic submueosal dissection （ESD）, 7 esophageal-tracheal fistula, 1 esophageal-mediastinal fistula, and 1 remnant stomach fistula. Distance from stenosis or fistula to central incisor was 15-20 cm in 48 cases, and more than 20 cm in 36 cases. All the patients were treated by 16 mm membrane- covered self-expanding metal stents. Main clinical manifestations and complications were evaluated. Results A total of 100 stents were placed in 84 patients,with a success rate of 100%. There were no complications such as perforation and bleeding during operation. Dysphagia and cough were improved quickly with a success rate of 100%. After the placement of stents, the incidence of complication was6.0%（5/84）, of which 2 cases were severe retrosternal pain, 1 was tracheal collapse, and 2 were stent displacement. Seventy-six patients （90.5%） received complete follow-up of 1 to 36 months （mean 15 months）. Re-stenosis occurred in 4 cases, new esophageal-tracheal fistula in 2 cases. Among these 6 cases, 5 cases underwent successfully stent placement once again, and another one case received Savary bougie and Argon-ion coagulation with good efficacy. Conclusion Endoscopic membrane-covered self-expanding metal stent placement is effective and safe for the relieve of dysphagia symptoms and the sealing of esophagotracheal fistula.