应用记忆合金带膜支架治疗86例食管恶性狭窄的体会

我院自2001年1月至2005年11月对不能手术的86例食管恶性狭窄的患者行置入记忆合金带膜支架术收到良好效果，总结如下：     

食管狭窄内支架置入临床应用28例

食管狭窄引起的吞咽困难,严重影响病人生存质量。我院采用国产镍钛记忆合金支架置入治疗食管良、恶性狭窄２８例。有效地缓解吞咽困难。方法简便,痛苦小,患者易接受,有推广价值。     

应用记忆合金带膜支架治疗食管恶性狭窄的护理

我院自2001年3月-2004年11月对不能手术的67例食管恶性狭窄的患者行置入记忆合金带膜支架术。效果良好，现总结如下。     

食管支架治疗食管良恶性狭窄：附23例分析

作者总结了采用２７根镍钛合金Ｕｌｔｒａｆｌｅｘ食管支架置入术治疗各种良恶性食管狭窄２３例。其中食管化学烧伤后狭窄１例，食管－胃吻合口狭窄６例，食管和／或贲门癌１６例。将吞咽困难分为０￣３级。２３例中，３级１２例，２级１１例。经治疗后，０级１３例（５６．５２％），１级６级（２６．０８％），２级３例（１３．０４％），３级１例（４．３５％）。其中，２级中的３例治疗前为３级，因此，总有效率为９５．６６％。     

国产带膜支架治疗食管狭窄和食管瘘的研究

探讨置入国产带膜食管支架治疗各种食管狭窄和食管瘘的效果。材料和方法采用国产不锈钢带膜支 架,在X线监视下用插送器经口置入食管病变部位。治疗食管病变所致食管狭窄26例,其中7例合并食管气管痿/纵隔 瘘;非食管病变所致气管食管瘘2例。结果28例均为一次置入成功,未出现技术问题及严重并发症。支架置入后食管 狭窄部位开通,食管瘘口封闭,患者症状均得到缓解。结论国产带膜食管支架适用于治疗各种食管狭窄和食管痿,支架 置入术简便、安全、有效。     

Palliative treatment of inoperable malignant esophageal strictures with conically shaped covered self-expanding stents

Purpose: To investigate the effectiveness of conically shaped covered self-expanding (Flamingo) stents in palliative treatment of malignant esophagogastric strictures in terms of patency, improved dysphagia score and survival.Material and Methods: Flamingo stents were placed under fluoroscopic guidance between August 1998 and December 1999 for palliation of malignant dysphagia in 33 cases. There were 21 males and 12 females aged 40-80 years (average 64.2 years).Results: Stent placement was successful in all patients, with good symptomatic control and no procedure-related complications. Spontaneous esophago-respiratory fistula and perforation accompanying malignant esophageal stricture in a total of 4 cases (12.2%) were successfully closed. In 1 case, tumor ingrowth was detected from the distal uncovered segment of the stent. In 2 cases with esophago-respiratory fistula, gastrointestinal bleeding occurred. The cause of hemorrhage could not be found by angiography. The mean survival time in 17 patients, later deceased, was 129 days (range 9-360), and the mean observation time in 16 patients still alive is 180 days (range 18-365).Conclusion: Flamingo stents provide an effective and safe choice of palliative therapy in inoperable malignant esophagogastric strictures.     

Hemolytic effect of deformed intra-arterial stents and stent grafts in vitro

Our objective was to evaluate the hemolytic effect of stents and stent grafts in an in vitro flow model. The model consisted of silicone tubings. Pulsatile flow was delivered at 1170 ml/min. Diluted packed erythrocytes were used (hematocrit of 33%). The Palmaz, MegaLink stents or Passager, Hemobahn stent grafts were placed in the middle portion of the model; control experiments contained no implant (n=10 each). Concentric stenosis of the implant was achieved by constricting the implant to 25, 50, or 70% (area, n=10 each). Samples were drawn at minute 1, 2, 4, 6, 8, 10, 15, and every 10 min up to 1 h. Hemolytic parameters were evaluated. All implants produced hemolysis, increasing in the course of time. Without deformation (0%) the Hemobahn stent causes less hemolysis compared with the other prostheses. At 25% no significant difference could be shown between all devices. At 50% constriction the Palmaz stent caused more hemolysis than the other grafts, and at 70% stenosis the Palmaz and Hemobahn caused more hemolysis than Passager or Megalink. A hemolytic effect was evaluable, probably due to mechanical stress and sheer forces, induced by turbulences in the proximity of the deformed stent. The stent grafts did not perform better than the stents. Differences in the design of a prosthesis and in the degree of stent deformation seem to have an influence on the hemolysis caused. Electronic Publication     

自膨式覆膜支架在食管、十二指肠恶性狭窄及瘘的临床应用

目的 评价食管、十二指肠恶性狭窄及瘘应用自膨式覆膜支架治疗的价值,探讨支架植入后常见的并发症及处理方法 .方法 87例上消化道狭窄或梗阻患者中,50例食管恶性狭窄,23例贲门-胃吻合口狭窄,5例胃、十二指肠恶性狭窄,3例食管瘘,6例食管吻合口瘘,共置入国产带膜网状支架95枚.结果 内支架置入全部一次成功,除1例患者术中急性出血外,余病例无即刻并发症,术后患者狭窄解除,饮食得到恢复,瘘道封闭,远期疗效与疾病性质和相关治疗情况有关.结论 自膨式覆膜支架治疗食管、十二指肠恶性狭窄及瘘疗效可靠,并发症少,术后加放疗和(或)化疗可进一步提高疗效.     

被膜支架治疗食管癌术后吻合口狭窄及食管气管瘘

目的：评价被膜支架腔内治疗和修补食管癌术后吻合口狭窄衣食管气管瘘的安全性和有效性。材料与方法：62个月内12例食管癌术后吻合口狭窄及食管气管瘘的病人使用16支被膜支架进行治疗。结果：支架置入的技术成功率为100％,被膜支架置入后术后吻合口狭窄有效缓解,食管气管瘘得到了严密封堵,肺内继发感染完全吸收。病人的临床状况得到了改善,其生活质量明显提高。结论：被膜支架置入缓解食管癌术后吻合口狭窄和修补食管气管瘘是一种安全有效的治疗方法。     

可取出式覆膜支架治疗儿童良性食管狭窄的临床体会

儿童食管狭窄以良性疾病为主,其病因主要有食管腐蚀性损伤、贲门失弛缓症、食管外科手术后吻合口狭窄、先天性食管狭窄以及胃食管反流并发症等引起的食管狭窄.男性较多见,通常认为超过80%发生于学龄前儿童,较常见于农村.主要表现为进食吞咽困难、咽后壁疼痛及食管炎症性病变等.     

食管内良恶性疾患支架治疗的疗效及影响因素

目的 评价内支架对食管良恶性狭窄患者行姑息性治疗的临床疗效。方法 入选57例患者，其中食管癌29例，贲门部癌10例，食管癌性狭窄伴食管气管瘘7例，贲门失弛缓症5例，手术后食管良性狭窄6例。病变范围2～14cm，平均7．3cm。病变按吞咽困难分级：I级12例，Ⅱ级31例，Ⅲ级14例。46例肿瘤患者在支架置放术后15～30d内进行放射治疗和动脉内化疗灌注联合治疗。结果 57例患者共置入内支架62枚，4例患者1次放置2枚，1例患者4个月后因支架移位上端再次狭窄．再次叠放支架。所有病例均1次成功。放置后7～15d梗阻、进食困难症状均明显减轻，7例伴食管气管瘘进食后呛咳立即消失。无严重并发症。5例贲门失迟缓症、6例良性狭窄至今存活。46例恶性患者的6个月存活率为67．4％(31／46)，1年为43．5％(20／46)，2年为26．1％(12／46)，3年为19．6％(9／46)。结论 内支架是治疗食管良恶性疾患有效的姑息性疗法，结合放射治疗和动脉内化疗将明显改善生存质量，提高生存率。良性狭窄采用内支架扩张，其疗效可与外科手术相媲美。     

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。     

Effective management of intrathoracic anastomotic leak with covered self-expandable metal stents. Report on three cases

Intrathoracic anastomotic leakage is one of the major complications of esophageal surgery that can lead to high mortality rate. Depending on the clinical presentation, therapeutic options include surgical reintervention and conservative management with or without external drainage or stenting. In this paper, we report a series of three patients, two men and one woman, mean age of 55.6 years (range 34–68 years), having intrathoracic anastomotic leak after esophagogastrectomy treated by insertion of four covered self-expandable metal stents performed exclusively under fluoroscopic view. Complete resolution of the leakage was obtained in all patients. Despite the limited number of patients, conservative management of intrathoracic anastomotic leaks with covered self-expandable metal stents performed under fluoroscopic guidance has proved to be rapid, safe, and effective in all cases of this series.     

食管支架治疗食管恶性狭窄的临床应用研究

目的：回顾性分析食管支架放置对恶性食管疾病的治疗并由此带来的生存质量的提高、生存期的延长以及食管支架放置过程中、术后出现的并发症及其相关因素。方法：利多卡因行口腔及咽喉部麻醉，置开口器，透视下将超滑导丝与8F大腔导管送入食管内，撤出导丝，经导管行食管造影标记定位病变区。导丝及导管进入胃内，置换不折导丝，部分病人行预扩张选择合适支架，沿导丝送至病变部位，透视监视下缓慢释放。结果：本组326例食管疾病患者共放置369枚食管支架，343枚支架一次放置成功，所有支架释放后即刻位置满意者337枚。放置支架后患者的一般状况很快得到好转。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、打嗝，其中l例于放置支架后30h因大出血死亡。结论：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。经口腔放置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。     

双支架（覆膜）治疗食管胃胸内吻合口瘘

目的：探讨双（覆膜）支架治疗食管-胃胸内吻合口瘘的疗效及操作方法。方法：回顾分析9例接受覆膜支架治疗食管-胃胸内吻合口瘘患者的临床资料。结果：9例患者,共植入9个双喇叭口自膨式镍钛记忆合金覆膜食管支架和8个覆膜针织支架。8例植入双支架的患者瘘口均达到完全封堵,另1例患者只放置1个覆膜食管支架的,术后1周造影发现经支架上口边缘仍有少许对比剂进入瘘口,给予保守治疗瘘口愈合。术后有5例患者出现胸骨后隐痛,1周后自动缓解。结论：双覆膜支架能完全封堵瘘口,安全有效。