被覆内支架治疗食管-气管瘘和食管狭窄的临床应用

目的评价应用被覆金属内支架治疗食管-气管瘘和食管狭窄病人的疗效。方法根据食管狭窄的程度、长度、瘘口部位及狮窄上缘距食管上端开口处距离，确定支架长度和支架位置。5例患者均在X线电视监视下完成操作。结果5例病人均1次成功放置被覆金属内支架，患者呛咳及吞咽困难症状消失，术后均能进普通流食。正侧位胸片检查，支架位置准确，形状为两头呈喇叭口样，中间狭窄部直径可达1．1cm～1．5cm。管瘘病人的二种很好的非创伤性姑息性治疗手段。结论X线透视下置入被覆金早内支架，是晚期食管癌合并食管-气管瘘病人的二种很好的非创伤性姑息性治疗手段。     

国产被覆自膨式金属内支架治疗恶性食管狭窄及食管-气管瘘

目的：评价国产被覆自膨式金属内支架治疗恶性食管狭窄及食管－气管瘘的效果和适用性。方法：利用DSA高清晰度X线电视造影、定位和监视释放。经口在0．038inch Amplatz直头导丝引导下，对食管癌引起的恶性狭窄12例置入单喇叭型；对癌性食管-气管瘘12例置入双喇叭型国产被覆自膨式金属内支架，随访3－10个月。结果：24个内支架一次性植入成功，患者可即刻吞食水，不再呛咳。结论：国产支架操作简单、 成功率高、安全、效果立竿见影，价值低廉能为众多患者接受。     

覆膜支架治疗食管恶性狭窄

晚期食管癌所致食管狭窄．严重影响吞咽功能，直接危及患者生命，并食管气管瘘者出现呛咳和肺炎表现更加重了患者的病情，食管覆膜支架的临床应用有效的解决了这一难题。笔者开展国产覆膜支架治疗食管恶性狭窄34例，3例并食管气管瘘，效果良好，报告如下：     

食管气管瘘的内支架治疗

<正>食管癌晚期出现食管气管瘘,我们采用带膜内支架治疗,效果较好,现报告如下。     

覆膜镍钛合金支架治疗恶性食管-气管瘘

食管-气管瘘会引起吞咽呛咳、肺炎，严重影响患者的食物及水摄入，直接危及生命。我们采用置入覆膜镍钛合金支架的方法治疗8例，取得了满意的效果，现报道如下。     

覆膜内支架治疗食管癌放疗后狭窄及食管气管瘘临床分析

目的评价覆膜食管内支架治疗食管癌放疗后狭窄及食管气管瘘的临床效果。方法本组89例食管癌放疗后狭窄及食管气管瘘的患者,其中并发食管气管瘘28例。食管内覆膜支架置入均在数字减影血管造影机(DSA)监视下进行。结果 89例患者均成功置入覆膜内支架,27例中上段食管气管瘘完全被封闭,进水呛咳症状消失。18例术后再狭窄,再次置入支架。结论食管覆膜内支架治疗食管癌放疗后狭窄及食管气管瘘安全有效,能提高患者生活质量,延长生存期。     

金属内支架治疗食管上段良恶性狭窄及食管-胃吻合口瘘

我院自 2 0 0 0年 7月～ 2 0 0 1年 7月对 6例食管上段 (相当于胸 1～胸 4椎体高度 )良恶性狭窄、食管胃吻合口瘘、结肠代食管结肠胃吻合口胸腔瘘行支架置入术治疗 ,现将有关资料及治疗效果报道如下。材料与方法本组 6例均为男性 ,年龄 5 4～ 6 3岁 ,平均年龄5 8岁。均有吞咽困难 ,合并气管瘘的患者饮流质时明显呛咳 ,消化道碘水、钡餐及胃镜检查均见食管上段狭窄及食管胃吻合口狭窄 ,碘水造影可见瘘口大小及走行。食管胃吻合口肿瘤复发狭窄合并气管瘘2例 ,食管胃吻合口瘢痕狭窄 2例 ,结肠代食管结肠胃吻合口胸膜腔瘘 1例 ,食管癌性狭窄 1例…     

癌性食管-气管瘘的带膜内支架治疗

目的评估食管带膜内支架治疗癌性食管-气管瘘的疗效。资料与方法20例癌性食管-气管瘘,15例合并肺部感染。共置入20枚食管带膜自膨式支架。结果18例一次性堵瘘成功,进食改善。14例肺部感染治愈,1例于术后1周大出血死亡。先期失败的2例,其中1例因持续肺部感染死亡,另1例禁食12天后自愈。结论食管带膜内支架置入是治疗癌性食管-气管瘘的有效方法。     

覆膜气管支架治疗气管狭窄伴气管瘘

目的将覆膜的直管型或分叉型气管支架应用于治疗恶性肿瘤造成的气管狭窄伴气管瘘,以维持呼吸通道和封闭瘘口。方法采用全部或部分覆盖硅橡胶薄膜的不锈钢丝“Z”型支架,使用带导引鞘的三套管支架输送器放置支架。结果9例气管支架均一次放置成功,6例食管内同时放置支架。术后呼吸困难的症状立即缓解,瘘口被封闭。随访观察4～12个月,无明显不良反应。结论采用覆膜直管型或分叉型支架治疗气管狭窄伴气管瘘是安全有效的方法。     

食管支架治疗恶性食管-气管瘘

目的探讨国产金属被膜内支架经食管置人,治疗食管一气管瘘的疗效。方法9例中,男7例,女2例,年龄46～72岁,平均53．4岁。因放疗引起食管一气管瘘食管癌3例,肺癌1例;肺癌支气管动脉灌注治疗后2例,手术后复发病人3例。全组病例均有饮水呛咳,吞咽困难,并均经手术或内镜病理证实,造影发现有食管一气管瘘口。病理结果为;小细胞肺癌2例：肺鳞癌1例;食管鳞癌6例。支架上端呈漏斗状,上下长于病灶2cm,支架到位后,用直径1．5cm球囊导管扩张,封闭瘘口,固定支架。结果5例可进普食,4例进半流食,1周后改进普食。结论带膜金属内支架治疗食管一气管瘘安全有效,是首选的治疗方法。     

上胃肠道良性狭窄的介入治疗随访研究和评价

目的 对上胃肠道良性狭窄介入治疗进行随访和评价。方法 85例上胃肠道（upper gastrointestinal tract,UGIT)良性狭窄患者,其中球囊导管扩张术组（A组）35例;永久性金属支架扩张组（B组）25例;暂性部分带膜金属支架扩张术组（C组）25例。在X线引导下,A组35例共进行67次球囊扩张,平均1．9次;B组25例安放部分带膜金属支架15只,不带膜金属支架10只;C组25例安放部分带膜金属支架25只,在支架术后3－7d由胃镜取出。治疗前UGIT管腔最窄处直径0．7－8．5mm,吞咽困难评分2－4级;治疗后UGIT管腔最窄处直径5．1－20．0mm,吞咽困难评分0－1级。所有患者术后随访6－36个月（平均19．1个月）。结果 A组术后并发症发生率为疼痛29％（10／35）、返流23％（8／35）、出血9％（3／35）;超过6个月的随访患者中20％（7／35）复发吞困难,超过1年的随访患者中91％（32／35）复发吞咽困难,超过3年的随访患者中95％（19／20）复发吞咽困难。B组术后并发症发生率为疼痛40％（10／25）、返流60％（15／25）、出血12％（3／25）、支架移位16％（4／25）;超过6个月的随访患者中60％（3／5）复发吞咽困难。C组术后并发症发生率为疼痛40％（10／25）、返流12％（3／25）、出血16％（4／25）;超过6个月的随访患者中12％（3／25）复发吞咽困难,超过1年的随访患者中13．3％（2／15）复发吞咽困难,超过3年的随访患者中12．5％（1／8）复发吞咽困难。结论 球囊导管多次分级扩张术和暂时性部分带膜金属支架扩张术是UGIT良性狭窄介入治疗近期疗效中的有效方法;暂时性部分带膜金属支架扩张术是UGIT良性狭窄介入治疗中远期疗效中的首选方法。     

Fluoroscopically guided balloon dilation for benign anastomotic stricture in the upper gastrointestinal tract

A benign anastomotic stricture is a common complication of upper gastrointestinal (UGI) surgery and is difficult to manage conservatively. Fluoroscopically guided balloon dilation has a number of advantages and is a safe and effective procedure for the treatment of various benign anastomotic strictures in the UGI tract.     

Treatment of malignant dysphagia with nitinol stents

Self-expanding nitinol stents were used in 22 patients for palliative treatment of malignant esophagogastric strictures. All patients but 5 were men (age range 47–75 years). The strictures were caused by squamous cell carcinoma (n = 12), adenocarcinoma (n = 8), and recurrent anastomotic carcinoma (n = 2). No technical failure or procedural complications occurred. After the procedure, the severity of dysphagia decreased at least one grade in all patients. Tumor ingrowth into the stent was seen in 7 patients of 22 (32%). Four of these patients were treated with additional stents, and in 3 patients, due to refusal, only balloon dilations were performed, which caused temporary relief. Tumor ingrowth into the stent was noted from 10 days to 7 months (mean 3 months). This seems to be a disadvantage of nitinol stents. At the end of the study 10 patients had died dead with a mean survival of 3 months (range 1 week to 6 months) and 12 patients were still alive with a mean follow-up of 4 months (range 1–8 months). It is concluded that nitinol stents provide satisfactory palliation in patients with malignant dysphagia with neglectable procedural morbidity and mortality rates.     

Crohn's disease of the upper gastrointestinal tract

Involvement of the upper gastrointestinal tract by Crohn's disease is being recognized with increasing frequency. Gastroduodenal disease is more common, although esophageal disease is now noted infrequently as well. There is nearly always concomitant involvement of the small bowel or colon. Initial phases of the disease are manifested as superficial inflammatory changes of the mucosa but can progress to scarring and stenosis. Optimum double-contrast technique is necessary to detect these early lesions.     

Endoscopic sonography of the upper gastrointestinal tract

Endoscopic sonography was used to examine the upper gastrointestinal tract of 550 patients referred for evaluation of abnormal findings seen on conventional endoscopy, upper gastrointestinal series, and CT. This essay illustrates the potential uses and limitations of this technique. Special emphasis has been given to the use of landmarks to facilitate orientation of the transducer in both the esophagus and stomach. Specific examples demonstrate involvement of individual layers of the bowel wall in both benign and malignant processes. It is stressed that this is a combined procedure requiring both an endoscopist and a radiologist. Endoscopic sonography is a valuable new technology with substantial potential in the evaluation of the upper gastrointestinal tract.     

气管恶性狭窄的内支架介入治疗

目的 介绍气管内支架留置的新技术,评价自张式金属内支架在气管恶性狭窄中的姑息治疗作用。方法 共１６例患者,其中气管腺癌所致狭窄８例,食管上段鳞状上皮癌所致气管狭窄６例,喉癌导致气管狭窄２例。临床上均有不同程度的呼吸困难,喘鸣,２例合并食管－气管瘘者伴有呛咳。所用器械包括：直径１４Ｆ前端部带有不透Ｘ线记号的支架释放鞘,支架推进器、导丝导管等。所用支架为Ｚ形不锈钢自张式支架和镍钛温度记忆合金支架。在透     

Endoscopic ultrasonography of the upper gastrointestinal tract.

Endoscopic ultrasonography combines the advantages of conventional endoscopy with the capabilities of ultrasonography. This permits the examiner to see through the wall of the gastrointestinal tract. The close proximity permits the use of relatively high frequencies, with the resulting increase in tissue contrast and resolution. There are limitations to its use, however, with the main one being a field of view limited to a 7-cm radius. Discussed in this article is its use for the gastrointestinal wall, the esophagus, the stomach, the duodenum, and the pancreas.     

Smooth muscle tumours of the upper gastrointestinal tract

The clinical and radiological features and endoscopic findings in 13 patients with smooth muscle tumours of the upper gastrointestinal tract are reviewed. The study emphasises the non-specific nature of the symptomatology and exemplifies a number of aspects of the radiological picture of these disorders. It also illustrates some of the problems that can arise in their investigation, by radiological and endoscopic methods, and gives some indication of the favourable prognosis that may obtain when complete surgical removal of the tumour is possible.     

Congenital anomalies of the upper gastrointestinal tract.

A wide spectrum of congenital anomalies may affect the upper gastrointestinal tract, including anomalies of the esophagus (e.g., atresia, fistulas, webs, duplications, vascular rings), stomach (e.g., congenital gastric outlet obstruction, duplications), and duodenum (e.g., atresia, annular pancreas, duplications, malrotation). The evaluation of affected patients can require multiple imaging modalities for diagnosis and surgical planning. Radiography is often diagnostic and specific and can usually provide important clues to help determine the optimal diagnostic procedure. Neonates with complete gastric or upper intestinal obstruction do not usually require further radiologic evaluation after radiography: Barium studies are usually contraindicated, and complementary procedures (e.g., ultrasound [US], computed tomography [CT]) are not usually helpful and may even delay surgery, resulting in death. Nevertheless, US has become important in the evaluation of the pediatric gastrointestinal tract and is being used in an increasing number of applications. CT and magnetic resonance imaging are unsuitable for general screening but provide superb anatomic detail and added diagnostic specificity. They are especially useful in demonstrating esophageal duplications and vascular rings as well as associated abnormalities. However, the decision to perform a given imaging examination should be considered carefully to avoid inconvenience or unnecessary radiation exposure to the patient or delays in surgical correction. Quality control programs should be in place to ensure safe, effective radiologic practice through use of up-to-date equipment and good imaging technique.