伸展型支架治疗食管良性狭窄

采用钛镍合金支架和Ｎ型带膜伸展型食管支架治疗食管贲门癌术后吻合口狭窄、食管癌放疗后狭窄、食管化学烧伤后狭窄和贲门失弛缓症等食管良性狭窄病人６５例,置管６８次,置管后吞咽困难程度明显改善,可免于手术痛苦。腔内支架回收器,可对支架移位、脱落者进行调整或回收,效果肯定,无严重并发症。     

食管狭窄食管支架置入术病人的护理

食管狭窄可由食管良性疾病和食管恶性疾病所致,且食管恶性肿瘤多数为晚期癌症病人,均有不同程度的吞咽困难。食管内支架置入术是继血管内支架成功置入后发展起来的一项新的技术,其操作简便、完全可靠、疗效显著,能有效解除病人吞咽困难等症状,提高病人生存质量,现已广泛应用于食管的各类狭窄型病变和晚期食管癌的非手术治疗。2000年至2007年我科采用食管内支架置入治疗各类食管狭窄35例,取得良好效果,护理报告如下:1临床资料本组病人35例,其中男20例,女15例;年龄42~70岁,平均56岁;晚期食管癌20例,食管癌术后吻合口复发致狭窄者6例,食管癌术后吻合口重度狭窄反复扩张后复发者5例,食管化学性烧伤瘢痕性狭窄4例,均有不同程度的吞咽困难,明显胸骨后不适感。其中4例出现严重营养不良、贫血等。本组35例均行食管内支架置入术,全部一次置架成功,多数病人术后2d能进少量温热流质,术后3 d能进半流质。术后15例无不适感,16例出现胸痛不适:恶心、返酸、发热等。经对症处理症状逐渐消失;2例出现严重的反流性食管炎,经对症治疗无效后取出支架;2例瘢痕性狭窄术后出现再狭窄,内镜无法取出,给予手术切除,食管重建治愈。2护理2.1心理护理:...     

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。     

食管、贲门、膈

DNA修复基因XRCCl多态与食管癌TNM分期及区域淋巴结转移的相关性研究,改良左胸小切口与常规开胸食管癌切除术疗效比较,刮吸显露食管癌的根治性手术89例报告,介入置管法在食管癌术后吻合口瘘治疗中的应用,经左胸食管床内食管胃弓上器械吻合术治疗中下段食管癌,X线联合内镜下食管支架置入术治疗食管癌性狭窄[编者按]     

带膜网状食管支架治疗食管狭窄43例临床应用体会

1 资料和方法 1.1 临床资料 本组43例,年龄42～70岁,平均53.2岁。其中食管癌36例,食管胃吻合口狭窄6例,贲门失弛缓症手术治疗失败1例。全部病例置人食管支架前均出现明显梗阻症状,有8例滴水未进8～16天。43例置入带膜网状食管支架均获成功,进食恢复通畅,观察时     

支架及人工贲门临床应用的新进展

目前，用置人支架法矫治重症晚期食管贲门癌及术后吻合口狭窄、瘘、癌复发、胃食管反流；治疗食管化学性烧伤、贲门失弛缓症和外伤性食管穿孔已被广泛采用。食管贲门癌切除后，在吻合口处植人人工贲门，可起到防反流、瘘和狭窄的作用。国内外医学文献检索尚未见到人工贲门临床应用的报道。     

食管良恶性狭窄支架成形术的临床作用

目的 探讨镍钛记忆合金支架在食管癌性梗阻、食管吻合口狭窄、吻合口瘘、贲门失弛缓症中的临床应用价值。方法 对22例食管良恶性狭窄,采用X线电视定位,经口插管技术,将金属支架准确送入狭窄段,支架膨开后,重新建立食物通道。结果 置管后,吞咽困难程度由术前平均3．1级改善为1．2级。2例吻合口瘘,1例食管气管瘘得到封堵。随访1～12个月,3例死于肿瘤恶液质。1例死于消化道大出血,其余18例尚在随访中。结论 食管支架成形术是治疗食管良恶性狭窄、吻合口瘘可选择方法之一,对提高患生活质量,延长生命发挥着重要作用。     

食管支架治疗食管狭窄55例

我们采用镍钛记忆合金支架治疗食管狭窄 ,取得满意疗效 ,现报告如下。临床资料　本组 5 5例病人中男 47例 ,女 8例。年龄36～ 73岁 ,平均 5 5 4岁。均有严重吞咽困难症状。食管良性狭窄 9例中吻合口狭窄 8例 ,瘢痕性狭窄 1例 ;狭窄范围为2～ 4ｃｍ ,狭窄部直径小于 0 5ｃｍ ,经扩张治疗 3次以上 ,狭窄直径仍小于 0 8ｃｍ。恶性狭窄 46例中食管癌合并气管瘘 40例 ,食管癌术后吻合口处复发 3例 ,食管癌合并纵隔瘘及肺、胸转移 2例 ,食管贲门双原癌并肝转移 1例 ;狭窄范围 6 0～16 5ｃｍ ,32例ＣＴ显示食管壁平均厚度为 1 9ｃｍ ;45例病理…     

自扩式食管支架术后并发症的诊治

１９９２年３月至１９９６年８月我们采用自扩式食管支架治疗食管狭窄病人１１６例，置入支架１２２例次，收到良好的效果。现就置入支架后并发症的有关问题讨论如下：临床资料本组１１７例病人中男８２例，女３５例。年龄４～８５岁，平均５７．５岁。其中晚期食管癌贲门...     

镍钛记忆合金网状内支架治疗食管狭窄

目的食管腔内放置镍钛记忆合金网状内支架，持续扩张食管、贲门部狭窄，改善患者饮食通道。方法利用内支架置放器等器械在Ｘ线下行食管狭窄扩张后放入适当长度的内支架。术后及２天、１月摄Ｘ线片对照。结果２８例均放置成功。术后定期复查，内支架膨胀、固定良好，内径最窄处平均直径１．３ｃｍ。２６例术后吞咽困难即消失。术后死亡９例，平均存活７个月。结论该术式简便、痛苦小、并发症少，解除梗阻快，有效地提高了患者生存质量，延长了存活时间     

Esophageal stenosis due to cartilaginous tracheobronchial remnants

In cases of congenital esophageal stenosis, tracheobronchial remnants in the distal esophagus should be considered a possible diagnosis. The cause is thought to be esophageal sequestration of a tracheobronchial anlage before embryologic separation. Primary resection of the stenotic portion of the esophagus with re-anastomosis is recommended. Such a case is reported.     

Rothmund Thomson Syndrome Associated with Esophageal Stenosis: Report of a Case

(Received for publication on Nov. 19, 1996; accepted on July 8, 1997)     

Esophageal motor function in congenital esophageal stenosis

Background/Purpose: Congenital esophageal stenosis (CES) is a rare condition that is associated with various foregut symptoms. The aim of the current study was to investigate esophageal motor function in pediatric patients with isolated CES.Methods: Four boys with CES (age, 3 weeks to 4 years old) were studied before treatment. The initial symptoms were dysphagia or stridor. The CES was caused by fibromuscular stenosis (FMS) in 2, tracheobronchial remnants (TBR) in 1, and membranous diaphragm (MD) in 1. An esophagram, endoscopy, 24-hour esophageal pH monitoring, and manometry were conducted.Results: The esophagram showed the stasis of contrast medium proximally to the distal esophageal narrowing in FMS/TBR patients. Endoscopic esophagitis was not found in any patients. Three patients were documented with pathologic esophageal acid exposure by 24-hour esophageal pH monitoring. Manometry showed that esophageal contractions predominantly were synchronous in FMS/TBR patients but were peristaltic in an MD patient. Basal lower esophageal sphincter (LES) pressure was at least 20 mm Hg in all. Swallow-induced LES relaxations were incomplete in FMS/TBR patients.Conclusions: The presence of gastroesophageal reflux and impaired esophageal motility are common in patients with CES.     

Esophageal stenosis in epidermolysis bullosum: a challenge for the endoscopist

Background/Purpose

Esophageal stenosis is a severe complication in dystrophic epidermolysis bullosa (EB). Endoscopic dilations may cause mucosal injury with stricture recurrence. Our aim was to describe our referral EB-center experience on safety and long-term efficacy of fluoroscopically guided balloon dilation without endoscopy.

Methods

Over 14 years, 34 patients with EB, previously evaluated with barium esophagogram for dysphagia, underwent balloon esophageal dilation. Under fluoroscopy, a guide wire was introduced via a nostril into the stomach. A 12-mm pneumatic balloon, which passed over the wire, was filled using radio-opaque contrast, dilating the stricture. Orotracheal intubation was avoided. Antibiotics, dexamethasone, and proton-pump inhibitors were administered. Study approval was obtained from our ethical board.

Results

Ninety-three dilations were performed. Seventeen patients had a single stenosis. The mean age of onset was 18 years (range, 3-47 years). Thirteen patients underwent one dilation. In 6 cases, endoscopy was necessary to visualize the esophageal lumen. Complications included cervical esophageal perforation (2) and transitory dysphagia (10). Thirty patients were feeding within 24 hours. During the follow-up, 2 patients required a gastrostomy, and 2 patients underwent fundoplication for gastroesophageal reflux disease.

Conclusions

Fluoroscopically guided balloon dilation in EB is a safe and well-tolerated procedure. An experienced endoscopy team is necessary in certain cases.     

Esophageal Intramural Pseudodiverticulosis Treated by Balloon Dilatation: Report of a Case

A 72-year-old man presented with a 17-year history of dysphagia, which had gradually become worse in recent months. A barium esophagogram showed stenosis of the upper thoracic esophagus with multiple tiny flask-shaped outpouchings along the region of stenosis. Based on this characteristic appearance, we diagnosed esophageal intramural pseudodiverticulosis. He underwent successful balloon dilatation of the stenosis and his dysphagia resolved. Dynamic esophagography showed improved passage through the esophagus. He has been well and not suffering from dysphagia for 4 years since the balloon dilatation.     

电化学治疗晚期食管癌梗阻和术后吻合口狭窄

１９９１年３月到１９９２年４月应用电化学疗法（ｅｌｅｃｔｒｏ－ｃｈｅｍｉｃａｌｔｈｅｒａｐｙ，ＥＣＴ）治疗有明显梗阻的食管癌病人２４８例和食管癌切除后吻合口狭窄病人３６例。全组病例均经食管钡餐造影、食管镜检查和部分ＣＴ扫描确诊。应用ＥＣＴ疗法是消除梗阻，使病人能进食，有效地改善营养状态，然后再根据具体需要辅以其它综合治疗，达到提高疗效的目的。２４８例食管癌梗阻的有效率为６７．７％（１６８／２４８），３６例吻合口狭窄的有效率为８８．９％（３２／３６），两组平均有效率为７０．４％（２００／２８４）。     

Esophageal stenosis after coil embolization of an aortopulmonary collateral artery: report of a very unusual cause

A 10-year-old boy who had previously undergone surgery for tetralogy of Fallot, pulmonary atresia, and ventricular septal defect was admitted with difficulty in swallowing and significant failure to thrive. His history included that he had 2 angiographically detected aberrant pulmonary arteries extending from the descending aorta to the right and left lungs, respectively. Both collaterals had been ligated during the corrective surgery; however, early postoperative evaluation revealed that the vessel that crossed behind the esophagus to the left lung had become recanalized. Coil embolization was performed to occlude this collateral. The patient had begun to develop swallowing difficulties 2 years after the embolization. Esophagography revealed a significant stricture in the middle of the esophagus, just anterior to the location of the coil in the vessel behind. The patient underwent a program of esophageal dilatation. This was successful, and he regained normal swallowing ability. To our knowledge, no similar case of esophageal stenosis has been reported in the English literature. We believe that inflammation surrounding the coiled aberrant artery, presumably caused by injury during the corrective surgery and resulting in hemorrhage, led to fibrosis around the vessel. This fibrosis also involved the adjacent esophageal wall, thus causing progressive stenosis.     

Esophageal atresia and tracheoesophageal fistula with distal esophageal stenosis: preoperative diagnosis

This is a presentation of a case of preoperative diagnosis of apparent esophageal atresia and an apparent distal and tracheoesophageal fistula from a peripheral hospital. After surgery, histopathologic findings showed the absence of cartilage and bronchial glands, suggesting the etiology as a fibromuscular stenosis.