带膜支架材料治疗晚期食管癌30例

背景：大量的临床报道证实覆膜支架材料治疗食管癌性梗阻改善率达95%以上,支架置入技术操作容易,治疗痛苦较小,比较安全。目的：回顾性分析带膜支架材料置入治疗晚期食管癌引起的管腔狭窄及食管气管瘘患者临床效果。方法：30例食管恶性狭窄患者,术前均行食道钡餐检查及胃镜病理确诊,并经食管覆膜镍钛合金支架材料置入治疗,回顾性分析其临床资料,评价支架材料治疗效果并探讨手术并发症的相关因素与对策。结果与结论：30例患者共置入37枚覆膜食管支架材料,均1次性置入成功。术后患者吞咽困难、呛咳症状迅速缓解消失,未发生严重的并发症。说明食管内带膜支架材料置入治疗晚期食管癌狭窄,能迅速缓解吞咽困难,使食管气管瘘呛咳现象消失,改善摄食状况。     

带膜支架材料治疗晚期食管癌30例

背景:大量的临床报道证实覆膜支架材料治疗食管癌性梗阻改善率达95%以上,支架置入技术操作容易,治疗痛苦较小,比较安全.目的:回顾性分析带膜支架材料置入治疗晚期食管癌引起的管腔狭窄及食管气管瘘患者临床效果.方法:30例食管恶性狭窄患者,术前均行食道钡餐检查及胃镜病理确诊,并经食管覆膜镍钛合金支架材料置入治疗,回顾性分析其临床资料,评价支架材料治疗效果并探讨手术并发症的相关因素与对策.结果与结论:30例患者共置入37枚覆膜食管支架材料,均1次性置入成功.术后患者吞咽困难、呛咳症状迅速缓解消失,未发生严重的并发症.说明食管内带膜支架材料置入治疗晚期食管癌狭窄,能迅速缓解吞咽困难,使食管气管瘘呛咳现象消失,改善摄食状况.     

全覆膜可取出支架在食管良恶性狭窄中的应用

[目的]探讨全覆膜可取出个体化设计支架治疗食管恶性狭窄的方法及疗效.[方法]采用国产全覆膜可取出个体化设计支架治疗食管恶性肿瘤18例;食管癌术后吻合口瘘8例;化学性烧伤3例;贲门失弛缓2例;医源性食管穿孔3例;食管癌术后吻合口非肿瘤复发性狭窄4例.[结果]所有的食管良恶性狭窄支架置入后均能顺利恢复进食.18例食管恶性肿瘤患者中没有出现术后再狭窄;8例食管癌术后吻合口瘘患者堵瘘均成功;3例医源性食管穿孔堵瘘成功,术后3个月取出支架,避免了外科手术治疗.[结论]个体化设计全覆膜可取出支架治疗食管良恶性狭窄疾病具有疗效确切,应用范围广,后续问题少的优点.但其是否存在食管黏膜组织增生,以及增生所致再狭窄的时间;如何更有效地防止支架脱落移位,良性狭窄支架取出的最佳时期的确定,还有待进一步临床观察.     

全覆膜可回收支架在常见食管狭窄病变中的临床应用

【目的】探讨全覆膜可回收支架治疗常见食管狭窄病变的方法及疗效。【方法】采用全覆膜可回收支架（个性化设计）治疗食管狭窄病变107例,其中食管恶性肿瘤59例,食管恶性肿瘤合并瘘2例,食管癌术后恶性狭窄1例,食管癌术后吻合口良性狭窄12例,镍钛记忆合金支架后上端组织增生致狭窄1例,食管癌术后吻合口狭窄并瘘11例,贲门失弛缓症11例,化学性食管狭窄6例,放疗术后致食管狭窄3例,食管间质瘤致食管狭窄1例。吞咽困难症状按Stooler分级术前、术后30d评分。【结果】所有的食管狭窄病变支架置入后均能顺利恢复进食,生活质量明显提高,吞咽困难症状按Stooler分级评分术后总有效率为95．3％。【结论】全覆膜可回收支架治疗常见食管狭窄病变具有疗效好、创伤小、并发症少等优点,值得临床推广运用。     

食管覆膜支架置入术和球囊扩张术在治疗中晚期食管癌中的临床价值探讨

目的:探究中晚期食道癌应用食管覆膜支架置入和球囊扩张术治疗的临床应用价值。方法:对我院收治中晚期食道癌患者110例进行回顾性分析,治疗前本组病例均有病理活检,患者均为不能手术或拒绝手术的患者。所有患者术前均行X线检查,确定病变部位、狭窄长度及与周围组织关系,本组病例均有在术前或术后配合化疗或放射治疗的情况。对110例患者分组,30例患者置入覆膜支架,对30例患者进行球囊扩张,对50例患者不分先后做了食管覆膜支架置入术和球囊扩张术。以术后狭窄扩张效果、生存质量及相关并发症进行比较分析。结果:支架置入成功率100%,平均生存期12个月,食道球囊扩张均经1~3次扩张达到预期效果,成功率70%,生存率9个月,食管覆膜支架置入术联合球囊扩张术治疗中晚期食道癌,总有效率100%,生存期平均16个月。结论:食管覆膜支架置入术联合球囊扩张术,在治疗中晚期食管癌能相对延长患者生存时间、提高生存质量方面明显优于单纯食道食管覆膜支架置入术及单纯球囊扩张术,患者疗效更高,具有理想的临床价值。     

可回收金属支架治疗难治性食管吻合口狭窄

目的评价可回收覆膜Z型支架治疗食管胃或空肠吻合口狭窄的安全性及其临床效果。方法食管吻合口狭窄患者26例,在X线监视下置入国产可回收Z型支架26枚,在支架置入后1~8周用胃镜或回收钩将支架取出。结果26枚支架均1次置入成功,支架置入后患者吞咽障碍均明显改善,能进普食,并在4~8周后成功取出。支架取出后随访13~60周(平均31周),2例患者发生再狭窄。结论可回收覆膜支架治疗难治性良性食管吻合口狭窄是一种安全、有效的方法。     

覆膜食管支架在食管穿孔40例的应用分析*

目的探讨全覆膜食管支架治疗食管穿孔的效果和安全性。方法采用全覆膜金属支架治疗医源性、肿瘤及异物所致食管穿孔40例,观察对其的治疗效果及并发症。结果所有的食管穿孔患者一次性成功置入食管支架,术后均能顺利恢复进食;食管异物临时支架植入术后4天~1个月取出支架,复查胃镜及食管造影均明确穿孔愈合;3例食管癌并穿孔患者术后吞咽梗阻感明显缓解。主要并发症为术后胸痛及支架移位,6例(15%)出现支架移位,2例(5%)食管癌患者出现食物梗阻并支架移位。结论全覆膜金属支架治疗食管穿孔,具有疗效确切,并发症少,安全有效等优点。     

全覆膜可取出支架置入术后常见并发症的原因及对策

[目的]探讨全覆膜可取出支架治疗各种原因所致食管良恶性狭窄患者后常见并发症的原因,寻找相应的对策,以减少并发症的发生.[方法]回顾性分析60例患者置入全覆膜可取出支架后出现并发症的原因及相应处置.[结果]60例患者共置入全覆膜可取出支架63个,一次性置入成功60个,二次置入成功3个,其中发生并发症:食物嵌顿5例;胸骨后疼痛6例;胃食管反流1例;支架移位及脱落10例(近端移位3例,远端移位4例,脱落3例);食管再狭窄2例,为肿瘤组织过度生长超过支架上下口引起;吻合口再次发生瘘3例;心律失常1例.支架移位为最常见原因,通过再次内镜下治疗或者更换支架,可以较好的处理并发[结论]向患者及家属详细交待支架治疗的原理,合理的饮食控制,根据病情个性化设计支架,提高支架置入技巧,可降低并发症的发生.     

血管内支架置入术治疗创伤性假性动脉瘤19例分析

目的探讨创伤性假性动脉瘤(traumatic pseudoaneurysm,TPA)应用血管内支架置入术治疗的效果及安全性。方法 19例TPA患者,12例行覆膜支架置入术,7例行多层裸支架重叠置入术,术后即刻造影了解治疗效果;随访观察症状改善情况,有无内漏及支架内狭窄等情况发生。结果 19例支架均成功置入,12例置入覆膜支架后造影显示假性动脉瘤消失,载瘤动脉远端血流均通畅;7例多层裸支架重叠置入后造影示动脉瘤基本不显影或显影浅淡,无重要侧支血管闭塞;术后随访6~47个月,中位随访21.3个月,1例多层裸支架重叠置入者术后1a行CT血管造影显示轻度狭窄(狭窄30%),无明显临床症状,余患者未见支架狭窄、移位、断裂,内漏等并发症。结论 TPA患者行覆膜支架和多层裸支架重叠置入术安全可行,近中期效果满意。     

内支架治疗消化道恶性梗阻的探讨

目的探讨内支架治疗消化道恶性梗阻和食管-支气管瘘的有效性和安全性。方法71例消化道恶性梗阻和食管-支气管瘘患者采用永久性部分覆膜镍钛合金内支架治疗,全部病例均在DSA监视下经口或肛门将支架置放于梗阻或瘘口部位,术前术后均做造影对照,根据进食进水和排便情况评价疗效。结果上消化道支架置入后恢复饮食,饮水后无呛咳62例(96.9%);乙状结肠和直肠支架置入后肠梗阻症状均即刻解除;术后支架移位2例(2.8%);再狭窄2例(2.8%);声音嘶哑1例(1.4%);胸部剧烈疼痛2例(2.8%),轻度疼痛12例(16.9%);大出血1例(1.4%),经相应处理后全部好转。结论永久性部分覆膜镍钛合金内支架置入术是消化道恶性梗阻和食管-支气管瘘的有效治疗方法,操作简便,安全性高。     

全覆膜金属可回收支架在治疗食管顽固性良性狭窄中的应用价值

目的探讨全覆膜金属可回收支架治疗食管顽固性良性狭窄的安全性及疗效。方法回顾性分析行全覆膜金属可回收支架治疗的33例食管顽固性良性狭窄患者的临床资料,评价治疗的可行性、安全性及疗效。结果 33例患者共计放置可回收支架41支,其中8例患者行二次可回收支架置入,术后均有不同程度胸痛及异物感;术后并发支架移位11例(共计14支),移位发生率34.1%(14/41);其余22例患者(共计27支支架)均于术后4~8周顺利回收。术中及术后无明显出血、穿孔等并发症发生,无支架相关死亡病例。所有患者定期参加随访(12个月),其中12例成功解除梗阻,临床缓解率为36.4%(12/33)。结论全覆膜金属可回收支架用于治疗食管顽固性良性狭窄是安全可靠的,可使部分患者成功解除梗阻,但支架移位发生率高,有待于临床进一步研究解决。     

内镜黏膜下剥离术治疗食管环周早癌的临床分析（附38例报告）

目的评价内镜黏膜下剥离术(ESD)治疗食管环周早癌的有效性、安全性和术后并发症情况。方法回顾性分析郑州大学第一附属医院2018年-2020年38例行ESD治疗食管环周早癌的患者的临床资料,按术后食管狭窄的治疗方式分为术后直接置入支架组(n=6)、未置入支架组(n=26)和因ESD术后狭窄定期扩张后再置入支架组(n=6)。结果环周缺损长度平均4.5 cm;术中穿孔1例、术后迟发性出血1例、术后发热5例、术后食管狭窄行扩张治疗中发生穿孔1例,术后穿孔的1例并发食管纵隔瘘,经保守治疗后好转。食管狭窄为其最常见的并发症,发生率为100.0%。患者平均住院8.6 d,平均手术时间186.8 min。ESD术后直接置入支架组的术后首次扩张时间及平均扩张间隔明显长于未置入支架组,因ESD术后狭窄定期扩张后再置入支架组置入后平均扩张间隔明显长于置入支架前,组间和组内比较,差异均有统计学意义(P 0.05)。平均随访时间507.0 d,患者无复发。结论 ESD治疗食管环周早癌是安全、有效的,虽然术后食管狭窄不可避免,但行食管扩张术或预防性支架置入/中途支架置入均能明显缓解狭窄进程,具有较良好的临床应用价值。     

Fully covered self-expanding metal stents for refractory pancreatic duct strictures in chronic pancreatitis

Fully covered self-expanding metal stents (FC-SEMSs), which can be removed from the bile duct, have recently been used in the main pancreatic duct (MPD) in chronic pancreatitis. The aim of this study was to investigate the feasibility, safety, and efficacy of FC-SEMSs in painful chronic pancreatitis with refractory pancreatic strictures. The primary endpoints were technical success and procedure-related morbidity. Secondary endpoints were pain relief at the end of follow-up and resolution of the dominant pancreatic stricture at endoscopic retrograde pancreatography. Over 5 months, 10 patients with painful chronic pancreatitis and refractory dominant pancreatic duct strictures were treated with FC-SEMSs. All FC-SEMSs were successfully released and removed, although two stents were embedded in the MPD at their distal end and treated endoscopically without complications. Mild abdominal pain was noted in three patients after stent release. During treatment, pain relief was achieved in nine patients, but one continued to take morphine, because of addiction. Cholestasis developed in two patients and was treated endoscopically; no patient developed acute pancreatitis or pancreatic sepsis. After stent removal, the diameter of the narrowest MPD stricture had increased significantly from 3.5 mm to 5.8 mm. Patients were followed up for a mean of 19.8 months: two patients who continued drinking alcohol presented with mild acute pancreatitis; one patient developed further chronic pancreatic pain; and one had a transient pain episode. At the end of the study, nine patients no longer had chronic pain and no patients had required surgery. Endoscopic treatment of refractory MPD stricture in chronic pancreatitis by placement of an FC-SEMS appears feasible, safe, and potentially effective.     

国产自膨式镍钛记忆合金食管支架的临床应用及疗效观察

目的：探讨国产自膨式镍钛记忆合金食管支架在食管、贲门良恶性狭窄及食管瘘中的临床应用并观察疗效。方法：收集我院2005年11月～2008年8月采用胃镜辅助置人镍钛记忆合金食管支架的患者108例,其中男90例,女18例,年龄37-88岁;包括食管癌性狭窄41例,贲门癌性狭窄5例,放疗后狭窄1例,肺癌压迫致食管狭窄1例,食管、贲门癌术后吻合口顽固性狭窄21例,食管癌术后复发致狭窄6例,食管瘘33例。结果：108例患者共置人食管支架116枚,一次性置人成功率100％,置入后患者吞咽梗阻的症状有不同程度的改善,呛咳的症状基本消失。结论：食管支架置人操作简单、安全,成功率高,是治疗食管良恶性狭窄及封堵瘘口的有效方法。     

Technical modifications and strategies for stenting gastric outlet strictures using esophageal endoprostheses

BACKGROUND AND STUDY AIMS: The outcome of stenting gastric outlet stricture is favorable compared with a bypass operation which has significant morbidity and mortality. In Japan, this procedure is particularly complicated by a lack of enteral stents. We report some technical stratagems for stent placement for gastric outlet strictures. PATIENTS AND METHODS: Between February 1993 and July 2001, 23 patients with gastric outlet strictures (14 men, nine women; mean age 72 years) underwent stent placement using an esophageal stent system. The Ultraflex or Z-stents were used in 18 or five patients, respectively. With the Ultraflex, we increased the length of the delivery system. Some patients underwent stent placement with the help of endoscopic assistance with a grasping forceps or a home-made sheath. RESULTS: The metal stent was successfully inserted in all patients. There were no complications during the procedure. Migration occurred in two out of five patients treated with the Z-stent, whereas there was no migration in patients treated with the Ultraflex stent. In two patients, curable pancreatitis was caused by pressure on the duodenal papilla. One of these patients also experienced bile stasis which required biliary decompression. There were three cases of obstruction, caused by tumor ingrowth (1), hyperplasia (1) and stent fracture (1); recanalization by an additional stent placement and/or cutting stent filaments was successful. All the patients died, with a median survival period of 52 days. There was no procedure-related mortality. CONCLUSIONS: With some technical modification, stent placement for gastric outlet stricture, even using an esophageal stent, is feasible. This procedure offers good palliation with no major complications.     

内镜下不同方式治疗难治性腐蚀性食管狭窄的临床研究（附3例报告）

目的 探讨内镜下不同方式治疗难治性腐蚀性食管狭窄的临床疗效。方法 回顾性分析3例分别行内镜探条扩张术、支架植入术及内镜下推进式放射状切开术（EPRD）治疗难治性腐蚀性食管狭窄患者的临床资料。结果 经反复内镜治疗后，3例患者均获得良好的治疗效果，术中及术后均未出现大出血和穿孔等严重并发症，并且随着治疗次数增多，狭窄缓解时间越长，吞咽困难改善也越明显。3种治疗方式中，支架植入术对吞咽困难的改善效果最明显。结论 内镜探条扩张术、支架植入术及EPRD治疗难治性食管狭窄均是安全可行且有效的方法。