带膜食管支架置人术32例临床疗效观察

目的：探讨带膜食管支架置入术治疗食管癌性狭窄和食管-气管瘘的临床效果。方法：32例晚期食管癌性狭窄和食管-支气管瘘患者,均无手术指征,术前已行内镜和X线钡剂造影检查明确病变部位和性质。术中应用利多卡因胶浆行咽喉部麻醉,置开口器,透视下将超滑导丝与5F导管送入食管内,撤出导丝,经导管注入造影剂确定病变上下端,体表用铅条标记定位病变狭窄区;导丝及导管进入胃腔内,置换不折钢丝,沿钢丝将支架送至病变部位,X线透视下缓慢释放,观察临床疗效。结果：所有患者吞咽困难均显著改善,食管-气管瘘患者呛咳显著缓解。但患者均有不同程度的胸痛、胸部异物感,平均缓解时间2周,支架术后平均存活13个月,并发症有疼痛、再狭窄、支架移位、胃内容物反流、出血、支架嵌顿填塞等。结论：带膜食管支架能显著缓解食管癌患者的进食困难及食管-支气管瘘呛咳、肺内感染、严重营养不良症状,提高患者的生活质量,延长生存时间。对于重度吞咽困难而又失去手术机会或拒绝接受手术治疗的食管癌患者,经口腔在X线透视下放置带膜食管支架是一种操作安全可靠、微创、简单易行、见效快、费用相对低廉的治疗方法。     

经鼻安放气道支架治疗恶性气管支气管狭窄

[目的]评价经鼻安放气道支架治疗恶性肿瘤引起的气管支气管狭窄的可行性和疗效.[方法]17例肺癌、食管癌等恶性肿瘤压迫或侵犯气管、支气管,引起气道狭窄和呼吸困难,在X线透视下由纤支镜配合进行,经鼻植入国产镍钛自扩型Wallstent支架.6例患者进行了后续的支气管动脉灌注化疗或放疗.[结果]10例狭窄位于主气管,置入支架10个;7例狭窄位于气管-支气管(4例)或支气管(3例)共置入支架11个.所有患者呼吸困难立即缓解.3例失访.8例未进行后续抗肿瘤治疗者生存时间45～90天,平均73天.6例术后进行放疗或支气管动脉灌注化疗者生存时间110天～1年6个月,平均12个月.[结论]在X线透视下由纤支镜配合经鼻行气道支架放置术优越性较多.国产气管支气管支架能缓解晚期恶性肿瘤引起的呼吸困难,改善生活质量;需结合后续的抗肿瘤治疗才能延长生存时间.     

内镜下放置覆膜食管支架治疗晚期食管癌癌性梗阻成功植入率的分析

目的探究内镜下放置覆膜食管支架治疗晚期食管癌癌性梗阻成功植入率的影响。方法选取75例晚期食管癌癌性梗阻患者,进行内镜下放置覆膜食管支架治疗方法,作为观察组,选取同期放弃内镜治疗的30例患者,作为对照组,进行回顾性分析。观察患者的支架置入成功率和并发症发生情况,生存期以及生存质量情况。结果采用内镜下放置覆膜食管支架治疗的患者成功植入率为97. 33%,患者吞咽困难问题得到明显缓解。进行内镜下放置覆膜食管支架治疗的观察组,6个月、12个月和18个月的累积生存率分别为98. 67%、89. 33%、69. 33%,放弃内镜治疗的观察组分别为53. 3%、36. 67%、23. 33%,两组存在明显差异(P <0. 05),具有统计学意义。观察组的生存质量评分(QOL)明显高于对照组,两组存在明显差异(P <0. 05),具有统计学意义。结论内镜下放置覆膜食管支架治疗晚期食管癌癌性梗阻成功植入率高,能够明显改善患者的症状,提高近期生存率和生存质量。     

Palliative Stenting With or Without Radiotherapy for Inoperable Esophageal Carcinoma: A Randomized Trial

Background

A majority of patients with esophageal cancer present with inoperable disease and require rapid and long-lasting palliation of dysphagia.

Study aim

To compare the duration of relief of dysphagia in patients with inoperable esophageal cancer treated with esophageal stenting alone or a combination of esophageal stenting and external beam radiotherapy (EBRT), and to assess overall survival, treatment-related complications, and quality of life (QOL) in the two groups.

Patients and methods

Patients with inoperable esophageal cancer and with high grade dysphagia were randomized to receive esophageal stenting with self-expandable metal stent (Ultraflex) alone (Group I), versus a combination of stenting followed by EBRT (30 gray in ten divided fractions over 2?weeks) (Group II). Dysphagia relief, overall survival, QOL (using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30, version 3), and treatment-related complications were assessed in the two groups.

Results

From April 2007 to March 2009, 84 patients were randomized to receive esophageal stent alone (42 patients) or a combination of stent and EBRT (42 patients). The two groups were comparable in demographics, tumor characteristics, indications for palliative treatment, and pretreatment dysphagia score. Dysphagia scores improved significantly in both groups following stent insertion. However, dysphagia relief was more sustained in Group II than in Group I (7 vs. 3?months, p?=?0.002). Overall median survival was significantly higher in Group II than in Group I (180 vs. 120?days, p?=?0.009). Addition of radiotherapy following stenting prolonged the mean dysphagia-free survival (118.6?±?55.8 vs. 96.8?±?43.0?days, p?=?0.054). There was significant improvement in all QOL parameters at 1?week after stenting. The QOL, however, significantly declined immediately after radiotherapy. There was no treatment-related mortality, and the incidence of complications was similar in the two groups.

Conclusion

Post-stenting EBRT effectively prolongs duration of dysphagia relief and improves overall survival in inoperable esophageal cancer.     

气管狭窄的放射治疗

目的:探讨气管狭窄行放射治疗的可行性和临床疗效.方法:对11例晚期恶性肿瘤所致气管狭窄的危重患者行姑息放疗.结果:所有患者在放疗过程中无死亡,呼吸困难均在1～2周内缓解,8例生存38～110天,平均74天,余3例随访6～20个月仍生存,无呼吸困难.结论:放射治疗可以作为缓解晚期气管狭窄、提高生活质量的一种有效方法.     

食管狭窄的支架治疗

目的介绍经内镜或开胸单纯探查术中放置自膨式食管支架治疗贲门和食管狭窄的方法及注意事项.方法1998年3月-2002年8月对41例食管、贲门狭窄患者进行了内镜下或开胸术中扩张及内支架置入术.结果38例一次性置入成功,2例异位经调整后达到满意,1例异位拒绝再行调整1个月后死亡,恶性病变28例中21例完成了放、化疗疗程,1年生存率67.8%(19/28).结论经内镜下放置食管支架操作简单、安全,疗效可靠,并发症少;开胸单纯探查术中放置自膨式食管支架是有效的补救治疗手段.     

Esophageal prothesis for neoplastic stenosis. A prognostic study of 77 cases

Esophageal prothesis (EP) is a palliative treatment for inoperable neoplastic stenosis. Ninety-one patients were candidates for EP placement between 1978 and 1983. EP placement was successful in 77 patients. Of these: 85% had primary esophageal cancer; 15% had bronchial or mediastinal carcinoma; 83% had stenosis in the middle third. Dysphagia was the main symptom in 84%, and tracheoesophageal fistulae in 16%. The observed median survival was 3.2 months +/- 1.9 (2 standard deviations [SD]), and the survival rate at 1 year was 7%. With the single-factor analysis method, not one of 12 factors presented any significance (age, sex, general status, anterior treatment, lesion site, endoscopic feature, stenosis diameter, histologic features, metastasis, tracheal involvement, symptoms, and type of prothesis). Two factors had a P value approaching significance: there were slightly longer survival rates in patients with a stenosis diameter less than 7 mm (P less than 0.07), and with stenosis located in the lower third and cardia (P less than 0.07). By multivariate analysis (Cox model), prognostic significance was found in only one factor: the location in the lower third and cardia (P = 0.002, relative risk = 3). The quality of life after EP placement was briefly improved: 80% of 73 evaluable patients had improvement in dysphagia for a mean duration of 3.7 months +/- 2 (2 SD), especially patients with a good general status (0 and 1; P less than 0.01); and 45% of patients had improvement of their general status for a mean duration of 4.1 months +/- 2 (2 SD). Minor complications related to EP placement were observed in 40% of patients (pain, obstruction, and mobilization), and severe complications were observed in 20% (perforation, 11 cases; fistulae, 5 cases, with death in 3 cases; hemorrhages, 4 cases). In conclusion, EP is a good palliative treatment, although complications are frequent, and evaluation of patient comfort is required to compare this procedure with other available techniques.     

Clinical Outcomes of Using a Conservative Approach of Late Esophageal Stent Placement in Palliation of Malignant Dysphagia

Background

Esophageal stents have been used as first-line treatment for palliation of malignant dysphagia, but this is associated with significant complications. The present study evaluated clinical outcomes and survival in patients with malignant dysphagia with esophageal stent placement who did not respond to prior chemoradiation or endoscopic modalities.

Patients and Methods

Patients with esophageal cancer, who had esophageal stents, were retrospectively reviewed from the electronic medical records. The patient demographics, type of stent placed, dysphagia scores, stent-related complications, and survival were recorded.

Results

Thirty-five patients with esophageal cancer received a total of 41 stents. There were 25 males and 10 females with mean age of 69.8 years. Twenty-two patients had esophageal adenocarcinoma, ten patients had squamous cell carcinoma, and three had poorly differentiated tumor. Esophageal malignancy was early stage (I, II) in 10 patients and advanced (III, IV) in 24 patients. Three patients had upper esophageal involvement, eight patients had mid-esophageal involvement; distal esophageal malignancy was present in 24 patients with 10 patients having gastroesophageal junction involvement. Six patients presented with tracheoesophageal fistula. Nine patients had prior esophagectomy. Thirty-three patients had chemoradiation, and 32 patients had other endoscopic therapies previously. Twelve of the 35 (33%) patients developed stent-related complications; nine patients had dysphagia due to various causes; one patient each developed aspiration, intractable hiccups, and intractable vomiting after stent placement, respectively. Nine patients underwent a repeat esophagogastroduodenoscopy. Development of stent-related complications was not significantly associated with poor survival.

Conclusions

The clinical outcomes for patients with esophageal stent placement for malignant dysphagia after chemoradiation and other endoscopic treatments is not worse than that reported in patients where esophageal stent placement was used as first-line treatment.     

The effect of external beam irradiation after endoscopic palliation of esophageal carcinoma

The aim of this study was to verify the value of additional external beam irradiation (EBR) after endoscopic palliation, regarding quality of life and survival rate. From January 1988 to December 1995, 99 patients with esophageal carcinoma (squamous cell carcinoma 61; adenocarcinoma 38) were reviewed, there were 84 males (mean age: 67 years) and 16 females (mean age: 65 years). Seventeen patients were in stage IIb, 45 stage III and 37 patients in stage IV. HDR-brachyradiotherapy (mean: 14.7 Gy) was carried out in all patients. Additional EBR (mean: 47.8 Gy) after endoluminal palliation was done in 51 cases. At 6-months follow-up swallowing of a semi-solid diet at least was possible in all patients and dysphagia was found with significant difference in favour to EBR only in stage IV (p=0.011). The Karnovsky performance status showed a difference in favour of EBR for stage III and IV (p=0.040 and p=0. 049, respectively). The median overall survival for EBR compared to no EBR was 10 and 7 months, with a 12 months survival rate of 60% and 16% (p=0.0012). However, considering different stages and EBR versus no EBR a significant difference in survival could only be found for stage IIb (p=0.031), a trend in favour of EBR could be found for stage III (p=0.0985) and stage IV (p=0.0543). Tumor regrowth 6-12 months after treatment occurred in 31 cases and was successfully treated with Nd-YAG laser in 25 and stenting in 6 cases. Postirradiation fibrotic stenosis occurred in 12 cases. Improved survival rates after additional EBR can only be expected in stage IIb. However, in case of advanced esophageal carcinoma and fair performance status, EBR after endoluminal palliation help to maintain quality of life.     

恶性梗阻性黄疸的内镜姑息治疗(附929例报道)

Objective:To review the experience with endoscopic palliative treatment for malignant obstructive jaundice (MOJ) in 929 patients. Methods:929 patients (598 males and 331 females) underwent 1215 endoscopic palliative drainages for MOJ in our hospital. Tumor obstruetion oeeurred in the distal common bile duet(CBD)(263 patients), the middle CBD (43),and the hilum(909).The mean bilirubin level was 284.3 μmol/L(range 26-810). Of the 1215 drainages, 599 were performed by stenting with plastic endoprosthesis, 385 by naso-biliary eatheterization, 167 by expandable metal stents,39 by combined drainage method,19 by tumor sphincterotomy and 6 by endoseopie fistulostomy. Results:The successful rate of endoscopic procedure was 94.3%. The jaundice symptom was improved in 81.8% of the patients with a significant reduetion of serum bilirubin in 64.7%. The complication after treatment occurred in 23 eases (2.6%), including eholangitis(23 eases), panereatitis (8 eases), and bleeding (one ease), and 3 eases were dead (0.2%).The median survival time of all patients was 14 months and life time analysis showed a life expectancy of 75.9%, 44.0% and 25.2% at 1, 2 and 3 years respectively. Conclusion:In the patients with MOJ seeondary to panereatobiliary malignancy, sueeessful endoscopic drainage provides adequate relief of biliary obstruetion and is associated with low morbidity and mortality. Enduseopie interventional treatment may be considered as an alternative of palliative biliary operation for the late stage of pancreatic and biliary malignaneies.     

Palliative Therapie des fortgeschrittenen Pankreaskarzinoms

In spite of advances in the management of other malignancies, the prognosis of patients with advanced pancreatic cancer remains poor. Palliative therapy is an essential element of the treatment strategy. In this review we discuss important areas of the palliative therapy of advanced pancreatic cancer. We focus on complications of pancreatic cancer, such as stenosis of the common bile duct, duodenal obstruction and thrombosis as well as on supportive therapy. The endoscopic implantation of self-expanding metal stents is a safe procedure with a high success rate to obtain adequate biliary drainage. In cases of malignant duodenal obstruction palliation is also mainly achieved by endoscopic stenting. A main area of supportive care is an appropriate pain treatment, following the WHO scheme for pain therapy. Weight loss in patients with pancreatic cancer is often due to pancreatic exocrine insufficiency, which is treated by supplementation of pancreatic enzymes.     

Effect of radiotherapy for inoperable remnant and recurrent gastric cancer--focusing of improvement in quality of life

We investigated six cases of inoperable remnant and recurrent gastric cancer treated with radiotherapy with regard to quality of life (QOL). The radiation dose was from 22 to 70 Gy, with a mean dose of 46 +/- 18 Gy. Four cases could be evaluated. Two were PR and two were NC. No patients could ingest food before radiotherapy, but two became able to eat whole gruel, one half gruel and three water. The mean survival time was 5.5 months and prognosis was not improved. Subjective symptoms such as food passage disturbance were decreased by radiotherapy and QOL was improved. Radiotherapy for patients with inoperable gastric cancer seemed to be effective in improving QOL.     

WallFlex? Duodenal Stent Placement in a Gastric Cancer Patient with Malignant Stenosis of a Roux-en-Y Gastrojejunostomy following Distal Gastrectomy

A 69-year-old Japanese woman with a history of distal gastrectomy with a Roux-en-Y reconstruction for advanced gastric cancer was admitted to our hospital complaining of severe dysphagia. On admission, the patient was only able to take liquids, and a firm, fist-sized tumor was palpable in her left upper abdomen. An endoscopic examination disclosed stenosis of the jejunal limb of the gastrojejunostomy. Abdominal computed tomography revealed that a recurrent tumor, 5.0 cm in diameter, was compressing the jejunal limb of the gastrojejunostomy. A knitted nitinol self-expandable metallic stent (WallFlex™ duodenal stent) was placed endoscopically at the stenotic jejunum from the gastrojejunostomy. The time required for stenting and total endoscopic manipulation was 12 and 35 minutes, respectively. No stent-related complications were observed. The patient could resume oral ingestion 1 day after endoscopic stenting and was discharged on the fifth day after treatment. She survived for 201 days after stenting. She continued oral ingestion for 194 days and stayed at home for 165 days. The WallFlex duodenal stent allows safe endoscopic stenting, even in cases of malignant stenosis of a gastrojejunostomy following distal gastrectomy. This stenting device will extend the indications for endoscopic palliation of gastric cancer patients with gastric outlet stenosis.Key words: Gastric cancer, Roux-en-Y gastrojejunostomy, Recurrence, WallFlex™ duodenal stent     

Outcomes in percutaneous stenting of non‐hepato‐biliary/pancreatic malignant jaundice

MELLER M.T., ARTS G.R.J. & DEAN J.R. (2010) European Journal of Cancer Care 19 , 664–668 Outcomes in percutaneous stenting of non‐hepato‐biliary/pancreatic malignant jaundice The aim of this study is to review the practice and outcomes at our institution of percutaneous transhepatic placement of metallic biliary stents for non‐hepato‐biliary/pancreatic (non‐HBP) malignant obstructive jaundice. A retrospective review was performed of the records of all patients undergoing transhepatic stenting for non‐HBP malignant obstructive jaundice over a 7‐year period. A total of 25 patients were successfully stented and linear regression analysis of a variety of demographic, clinical and laboratory markers against survival was performed. Survival after stenting varied from 1 to 1354 days (median 58, mean 152). An initial bilirubin level less than 300 µmol/L (P= 0.01) and a reduction of greater than 50% in bilirubin post stenting (P= 0.02) were strong predictors of improved survival. Older patients survived longer than younger ones (P < 0.01). There was a weak association of survival with an albumin >30 g/L (P= 0.06), but no statistically significant correlation with creatinine or haemoglobin levels or active tumour treatment after stenting. There were few major complications from the procedures. Transhepatic metallic biliary stenting for non‐HBP malignant biliary obstruction is a safe and effective procedure, and with careful patient selection, significant periods of survival and palliation of jaundice can be achieved.     

Evaluation of biliary stenting therapy for malignant biliary stricture at our hospital

The clinical results of biliary stenting therapy for non-resectable malignant biliary stricture were assessed for patency periods and survival periods in consideration of the types of stents and disease. The subjects were 51 patients with non-resectable malignant biliary stricture due to disease of the pancreas and biliary tract treated at our hospital between April 2001 and March 2005. No significant differences were observed in the patency periods and survival periods among the various types of stents. In regard to the type of disease, the survival period for biliary tract cancer was longer (616 +/- 246 days) than those for other diseases. There was no difference in the number of times of stenting among the various stents, and jaundice was effectively reduced. No patients in our series died of failure to reduce jaundice. We therefore considered it necessary to choose a proper stent indwelling route and a stent type according to stricture site, disease type and PS (performance status) at the time of stenting. The usefulness of the biliary stenting therapy for non-resectable malignant biliary stricture was suggested.     

Airway stenting for malignant respiratory complications in esophageal cancer

Airway stenting is required for the palliative treatment of advanced esophageal cancer. This study retrospectively analyzes the outcomes of airway stenting for esophageal cancer at our institution. Data from nine patients who underwent airway stenting were reviewed. All patients had poor respiratory status due to esophagorespiratory fistula and/or respiratory stenosis. We retrospectively assessed the results of airway stenting as five grades of respiratory symptoms, regarding stent-related complications and clinical course and survival. Six silicone and six covered self-expandable metallic stents were deployed in five and six patients, respectively. Two types of airway stents were deployed in two patients, and double stents were positioned in the airway and in the esophagus of three other patients. The grade of respiratory symptoms improved in seven patients. The mean dyspnea grade was 3.0±0.9 and 1.3±1.3 before and after airway stenting, respectively. Stent-related complications comprised of chest pain, incomplete closure of the ERF, sputum retention and stent migration. The mean±SD survival of all patients was 103±108 (range, 0 to 325) days, and the survival of patients without relapsed cancer at the time of stenting, who underwent cancer-specific therapy after stenting, was prolonged. Although the airway should be stented according to the status and the prognosis of each patient individually stenting can relieve symptoms and improve the prognosis even when esophageal cancer is at very advanced stages. Airway stenting could play a role in the multidisciplinary management of advanced esophageal cancer.     

国产自膨式镍钛记忆合金带膜食管支架的临床应用

背景与目的：晚期恶性食管狭窄、食管癌或贲门癌术后单纯吻合口狭窄、食管癌放疗后狭窄所致的进食困难甚至出现食管气管瘘、食管纵隔瘘是影响患者生存质量及生存时间的一个重要因素。如何微创、简便、有效的治疗上述食管狭窄或食管气管瘘、食管纵隔瘘一直是临床工作者研究的热点之一。本研究探讨国产自膨式镍钛记忆合金网状带膜支架治疗食管狭窄的价值和注意事项。方法：自1998年4月至2005年10月，我科采用国产自膨式镍钛记忆合金网状带膜支架治疗食管狭窄患者96例（其中食管恶性狭窄65例，包括食管气管瘘18例、食管纵隔瘘3例；食管癌或贲门癌术后单纯吻合口狭窄26例；食管癌放疗后狭窄5例），男性71例，女性25例，平均年龄70岁。所有患者均在X线辅助下行食管内支架置入术。结果：本组共置入食管内支架114枚，均一次成功，成功率100％，近期疗效满意。随访1～60个月，无一例发生支架移位，术后平均生存时间8．6个月。恶性食管狭窄行内支架置入后联合化疗，中位生存期7．4个月。本组患者术后再狭窄率38．5％，予球囊扩张或再次内支架置入治疗（再次介入治疗29．2％）。结论：食管内支架置入是恶性食管狭窄的良好的姑息性治疗手段，也适用于食管癌或贲门癌术后单纯吻合口狭窄、食管癌放疗后狭窄，有助于延长患者生存时间、提高生活质量。但如何降低食管内支架置入后的再狭窄仍有待进一步的研究。     

Severe complications in advanced esophageal cancer treated with radiotherapy after intubation of esophageal stents: a questionnaire survey of the Japanese Society for Esophageal Diseases

PURPOSE: A questionnaire survey was performed to evaluate the complications and prognosis of esophageal cancer treated with esophageal intubation before or during radiotherapy. METHODS AND MATERIALS: Clinical data were accumulated on a total of 47 patients treated at 17 institutions in Japan. Five patients had Stage II, 30 Stage III, and 11 Stage IV, and the stage was unknown in 1 patient. Covered expandable metallic stents were inserted in 30 patients, uncovered expandable metallic stents in 13, plastic or silicon prosthesis in 3, and an unknown type in 1 patient. Esophageal stenting was performed before the start of RT for 23 patients and during the course of RT for 24 patients. The reasons for the stenting were severe stricture in 32 patients (Group 1) and esophageal fistula in 15 patients (Group 2). RESULTS: The most frequent toxicity was formation or worsening of esophageal fistulas in 13 patients (28%), followed by massive hematemesis or GI bleeding in 10 patients (21%). In total, 24 patients (51%), including 10 patients with possible treatment-related deaths (Grade 5), had nonhematologic toxicities of Grade 3-5. The interval from the start of RT to the nonhematologic toxicity ranged from 16 to 312 days (median 78). The incidence of toxicities was higher for Group 1 (59%) than for Group 2 (33%), although the difference was not statistically significant. The median survival time for those with Stage II-III and Stage IV was 5 and 3.5 months, respectively. CONCLUSIONS: Patients with esophageal intubation before or during RT have a high risk of life-threatening complications, especially for those with severe esophageal stricture. Because long survival is expected for a substantial proportion of patients with locally advanced esophageal cancer after chemoradiotherapy, palliative intubation should be delayed until radiotherapy or chemoradiotherapy appears to have failed.     

Esophageal cancer in California 1942-1969: the California Tumor Registry experience

An analysis of the 3,319 cases of esophageal cancer (ICD No. 150), 1942-1969, from the California Tumor Registry was performed, and related data are examined. Esophageal cancer predominates in the Negro race, urban areas in California, and the lower socio-economic classes. Esophageal cancer occurs at a median age of 63.8 years and has a male-female sex ratio of 2.84:1. Despite an increase in the percentage of cases localized at the time of diagnosis, the five-year survival rate (localized cases) for esophageal cancer patients has remained constant at 7%. The mean survival from the time of diagnosis for all stages of the disease was 5.2 months. Although there has been a slight increase in incidence of esophageal cancer, the mortality rate has remained constant at 2.4/100,000 (age-adjusted). While more patients have been treated with surgery and/or radiation, this has had a negligible effect on the relative survival rates for esophageal cancer.     

内镜下射频结合食道支架治疗食管恶性梗阻的临床分析

目的：探索经内镜射频、扩张结合食道支架治疗食管恶性梗阻的临床应用价值。方法：在内镜直视下,运用射频电极、扩张器和食道支架对食道癌术后复发病灶和晚期食道癌所致管腔狭窄进行治疗。25例食道恶性梗阻内镜不能通过患者,其中18例患者经过1次射频治疗后胃镜顺利通过狭窄口,后再行食道支架置人;7例患者经过2次射频治疗后食道管腔变宽但胃镜仍不能通过,予扩张后行食道支架置入。结果：25例患者随访1—12个月,无严重并发症,所有患者经治疗后营养迅速恢复,停止静脉补液。结论：经内镜下射频、扩张结合食道支架置入术是食道恶性梗阻较理想的姑息治疗方法,且设备价廉,操作简单,安全性高,易于推广应用。