内镜直视下放置食管支架治疗食管狭窄的可行性研究

１９９６年１２月起,我院采用国产食管金属带膜支架在内镜直视下放置的方法,治疗各种良、恶性疾病所致的食管狭窄,收到良好的效果,现报道如下：一、临床资料：本组共３２例,男２２例,女１０例,年龄４０～８４岁,平均６５岁;食管癌术后吻合口狭窄１１例,食管癌术后复发６例,无法手术食管癌８例,贲门癌４例;食管癌放疗后狭窄３例。狭窄长度为３～１５ｃｍ,其中３～５ｃｍ２２例,６～１０ｃｍ８例,１０ｃｍ以上２例。狭窄内径为０．３～０．５ｃｍ,狭窄位于食管上段１例,中段１７例,下段１４例。临床均有吞咽困难,按吞咽能…     

金属食管支架治疗食管恶性狭窄——附13例分析

近些年来国内外应用多种食管支架治疗无法手术切除的食管癌、贲门癌,以及应用带膜支架治疗食管气管瘘取得较为满意的效果。1994年3月至2001年     

食恶性食管狭窄患者放射治疗后致食管支架置放困难及放效的影响

目的 总结放疗前后行有效食管扩张及支架置放的疗效。方法 未行放疗及放疗后两组均用锥形塑料探条扩张器扩张食管狭窄段，扩至１３ｍｍ时采用置入器置入支架。结果 ５３例中未行放疗的３０例，扩张均为显效，显效率达１００％（３０／３０），支架均１次顺利置放成功，成功率达１００％（３０／３０）；行放疗的２３例中扩张及支架置放的总效率仅为１７．３９％（４／２３）；未行放疗组和放疗组扩张的显效率，支架置放的成功率二     

被膜食管支架治疗食管贲门良性狭窄32例

目的:评价被膜食管支架治疗食管贲门良性狭窄的疗效和安全性.方法:选择食管贲门良性狭窄患者32例,根据不同患者选择合适的被膜食管支架置入狭窄段.观察操作成功率、吞咽困难改善情况、术中术后并发症的发生及其处理等.结果:32例均一次性成功置入支架,支架置入后吞咽困难症状均得到持续改善.所有患者未出现食管穿孔、出血等严重并发症,但均出现不同程度的胸骨后闷胀隐痛不适,其中4例患者胸痛较明显,肌注止痛荆后缓解:3例出现支架脱落:1例出现支架近端肉芽组织增生.支架置入后可有效封闭食管气管瘘、食管纵隔瘘等.术后6 mo可经内镜成功取出支架.结论:内镜下置入被膜食管支架是治疗食管贲门良性狭窄的一种安全、有效的方法.     

改良型多功能食管支架置入器的临床应用

自1998年5月至2003年7月，我们采用钛镍记忆合金支架治疗食管、贲门恶性狭窄172例。同时，与厂家联合试制了既能行支架置入，又能代替大孔道双腔胃镜作用的多功能食管支架置入器。经此置入器成功的调整和取出支架39例，效果满意，现报告如下。     

经纤支镜同时置入气管支架和食管支架治疗气管和食管狭窄

气管金属支架和食管金属支架近年逐步应用于临床，对呼吸困难和吞咽困难症状均能起到缓解症状，解除患者痛苦的作用。但经纤支镜单独置入气管支架和胃镜置入食管支架报道颇多，经纤支镜同时置入气管支架和食管支架的报道少见。2002年6月至2003年10月，我们用此方法治疗晚期癌症所致气管食管双狭窄患者10例。现报告如下。     

食管支架治疗食管狭窄16例临床分析

食管支架治疗食管狭窄１６例临床分析淄博市博山区医院（２５５２００）山东省千佛山医院刘同学周祝谦我们对１６例食管良恶性狭窄患者采用食管支架置入术治疗，取得较好效果。现报告如下。１资料与方法本组男１１例，女５例；年龄４２～８３岁，平均５６．８岁。食管—胃...     

镍钛合金支架治疗食管狭窄

1996年1～9月,我们采用镍钛记忆合金支架治疗食管狭窄患者17例,效果明显。1 临床资料 本组男14例,女3例;年龄32～73岁,平均60岁。病程为半月至2年8个月,平均7.2个月。均以吞咽困难就诊,其中不能进食6例,仅能进流质8例,进半流质3例。狭窄原因为术后吻合口疤痕12例,食管癌4例,贲门失弛缓症1例。均经上消化道钡餐或胃镜检查确诊。狭窄位于上段食管2例,中段7例,下段4例,贲门4例。最窄处直径0.1～0.5cm,平均0.3cm;平均狭窄长度为4.15±3.5cm(1～12cm)。2 方法 空腹8小时以上。术前咽部局麻,肌注安定及654—2。采用Olympus XQ20型纤维胃镜,岛津500MAX光机,美国Cook公司出品的SAVARY—GJLLIARD食管狭窄扩张器,常州医疗仪器研究所出品的镍钛记     

定位器辅助放置食管支架

我院自 1997年 8月～ 1998年 5月采用定位器辅助行非 X线透视下非胃镜直视下放 置食管支架（以下称定位器法）治疗食管狭窄 51例,位置准确无误,疗效明显,现报告如 下。 一、资料和方法 1.临床资料： 51例中男 37例,女 14例。年龄 57～ 74岁。食管癌性狭窄 19例, 食管癌放疗后狭窄 20例,食管（贲门）癌术后吻合口狭窄 10例,吻合口癌复发 2例。 51例中 43例能进流汁饮食, 8例不能进食。食管狭窄长度最长为 18 cm,最狭窄者直径 不足 0.2 cm。 2.材料和方法：支架为江苏西格玛公司 CZES型带膜食管支架及输送器,其中用于食管 下段 、…     

食管内脏高敏感及其相关研究进展

胃食管反流疾病(gastroesophageal reflux disease,GERD)是一种较普遍的疾病,经常伴随各种不适症状,需要利用健康护理资源.在动物实验与人类实验研究中均表明,各种传入神经的受体在暴露于酸的情况下均可以敏感化,以至于使更多的感觉刺激通过传入神经输入到脊髓背角神经元,导致了这些神经元的阈值降低,使得他们的感受范围增大.这种敏感性增高的初级传入神经被形容为外周敏感化,而随之增加敏感性的脊髓背角神经元被描述为中央敏感化.一旦这些机制建立起来,可以使组织对以前原本无害的刺激发生敏感,并且会保持一个长期的过程.此外,心理压力和机械刺激都已经被证实可以使细胞间隙增宽,因此可能促进外围敏感化.目前,外围与中枢敏感化被认为是食管疼痛和高敏感的重要机制,甚至生理量的酸亦可以导致症状的发生.对于这些患者的治疗目的主要是降低神经的敏感性.本文主要围绕食管内脏感觉高敏感作一简要综述.     

Dynamic esophageal stents

Esophageal stenting represents a new strategy in the treatment of resistant or recurrent stenosis that obviates the need for multiple dilations. Our custom dynamic stent (DS) improves esophageal motility unlike the widespread self‐expandable plastic or metallic esophageal stents. The DS allows food and secretions to pass in the space between the esophageal wall and the stent wall. This contrasts with the other types of stent, in which food passes into the stent that presses into the esophageal wall. Until the stent patent is complete, we use slices of silicon drains overlapped with each other to fashion the stent to the desired length and diameter (7‐, 9‐, or 12.7‐mm external diameter). It is built coaxially on a nasogastric tube that guarantees the correct position. The two ends are tailored to allow an easy introduction and food passage between stent and esophageal wall. The stent is inserted after stricture dilations (Savary‐Gilliard dilators) under fluoroscopic guidance. All patients who underwent stenting were treated with dexamethasone (2 mg/kg/day) for 3 days and proton pump inhibitors (omeprazole or lansoprazole, 1–2 mg/kg/day). From 1992 to 2012, 387 patients (mean age 38.6 months; range 3–125 months) with post‐surgical esophageal stricture because of esophageal atresia correction were enrolled in this study. Twenty‐six of 387 patients (6.7%) underwent custom DS placement for recurrent stricture instead of a program of serial dilations. The stent was left in place for at least 40 days and was effective in 21 (80.7%) of 26 patients. There were two stent‐related major complications (subclavian‐esophageal fistula). Our custom stent represents an effective and safe option in the treatment of severe and recurrent post‐surgical esophageal strictures. Surgery with stricture resection, and reanastomosis or jeunoplasty represents the rescue strategy.     

Self-expanding plastic stents in treatment of benign esophageal conditions

BACKGROUND: Recently, self-expanding plastic stents (SEPSs) have been proposed for the treatment of benign esophageal disease. OBJECTIVES: Our purpose was to review our experience with SEPSs in patients with benign esophageal conditions. DESIGN: This was a retrospective case review of patients who underwent SEPS placement for benign esophageal disease, including (1) benign stricture, including reflux disease, ischemia, and idiopathic, (2) radiation-induced strictures, (3) anastomotic strictures, and (4) esophageal leak/fistulae. PATIENTS: Nineteen male and 11 female patients (average age 52.1 years, range 11-87 years) underwent SEPS placement. INTERVENTIONS: SEPS placement. MAIN OUTCOME MEASUREMENTS: Initial complications, stent migration, long-term complications, and treatment success according to clinical symptoms, follow-up endoscopy, or imaging. RESULTS: Eighty-three of 84 SEPS placements were successful. The most common complications were chest pain, dysphagia, nausea, and vomiting. No deaths were reported from stent placement. Stent migration was more frequent in proximal (30/44 stents, 68.1%) and distal (19/27 stents, 70.4%) compared with mid esophageal (3/10 stents, 30%). Migration was more frequent in stents placed for benign strictures (18/22 stents, 81.8%), anastomotic strictures (18/24 stents, 75%), and fistulae/leak (13/22 stents, 59.1%) compared with radiation-induced strictures (4/14 stents, 28.6%). Only 5 of 83 interventions (6%) resulted in long-term improvement after stent removal. LIMITATIONS: This was a retrospective review, and patients were selected from a tertiary medical center. CONCLUSION: Use of SEPSs for benign esophageal conditions resulted in frequent stent migration and few cases of long-term improvement. Further investigation is warranted to identify optimal patient populations and to guide future recommendations for the use of SEPSs.     

Use of stents in benign and malignant esophageal disease

The currently available endoscopic treatment modalities for the palliation of malignant dysphagia outside of self-expandable stent placement are, as yet, not optimal for achieving rapid and sustained dysphagia relief with minimal morbidity and mortality. Self-expanding stents are effective in improving dysphagia; however, the number of re-interventions needed for management of recurrent dysphagia remains higher than initially anticipated. The introduction of newer-generation stents may reduce stent migration and nontumoral tissue overgrowth and result in a decrease in the need for re-intervention. The use of self-expandable stents for benign esophageal disease has shown promising results for the treatment of anastomotic leaks and perforations. However, the data on benign esophageal strictures have been mixed. Multicenter, prospective studies are needed to evaluate the late complication rate and long-term effectiveness in this difficult-to-treat patient population with refractory esophageal strictures. Future developments in stent design include biodegradable stents, stents with a radioactive coating, and drug-eluting stents.