胃十二指肠良恶性狭窄的内支架治疗

目的探讨金属内支架在治疗不能手术的胃十二指肠交界处良恶性梗阻中的作用、疗效和并发症。方法１１例病人，８例术后吻合口复发狭窄，１例胃幽门良性狭窄，２例恶性狭窄。在透视监视下，使用介入放射学方法置入１１个自膨胀式金属内支架。结果１１例病人支架置入均成功，１０例梗阻症状立即解除，随访期间病人均能进食，疗效满意。本组无严重并发症发生。结论介入放射学置入金属内支架是一个简单、有效的治疗方法，对不能手术的胃出口部狭窄和术后吻合口狭窄有很好的缓解作用。     

食管内支架置入术并发症分析

目的：分析内支架置入术治疗食管良恶性狭窄的并发症并提出防治方法。方法：本组５８例,其中食管化学烧伤后狭窄２例,食管－胃吻合口狭窄１１例,食管癌３７例,胃贲门癌８例,支架置入在Ｘ线电视监视下进行。术后给予抗生素、止血药及镇静止痛药,２３例食管癌患者术后行放疗、化疗。结果：１例内支架异位留置,遂加置一根支架,其余５７例支架的一次置入成功,术后 后疼痛２１例,大出血１例,随访１～６个月,食物嵌顿１例,支     

金属内支架治疗胃大部切除引起的瘢痕狭窄

目的：探讨金属支架治疗胃大部切除引起的瘢痕狭窄。方法：30例金属支架治疗胃大部切除引起瘢痕狭窄造成的梗阻。分别置入自扩型金属支架，11例患者进行了后续治疗。结果：30例狭窄都位于吻合口，共置入30个（uhroflex）支架。所有患者梗阻立即缓解，经过12-20个月的随访，出现反复炎症5例，支架网眼内肉芽增生形成阻塞4例，便潜血3例。支架移位2例，经处理后均保持畅通。结论：金属内支架对胃大部切除引起的癜痕狭窄有良奸的作用。预防和控制感染、出血并处理肉芽组织增生，是保持支架畅通的良好方法。     

支架置入治疗胃十二指肠恶性梗阻12例

胃十二指肠恶性梗阻是指胃、十二指肠或其周围脏器恶性肿瘤浸润、压迫胃十二指肠，导致胃十二指肠输出道狭窄或梗阻，并引发进食障碍，上消化道梗阻，食管炎和电解质紊乱的一种严重的恶性肿瘤并发症。近年来，随着支架置入术成功地应用于食管、胆道和血管狭窄性疾病，支架置入治疗胃十二指肠恶性梗阻也为患者提供一种新的选择。我们总结12例支架置入治疗胃十二指肠恶性梗阻的临床效果和并发症，并报道如下。     

上消化道恶性梗阻内支架置入术后的常见并发症及处理

目的　探讨上消化道恶性梗阻内支架植入术后常见并发症及处理方法。方法　 12例上消化道狭窄或梗阻患者中 ,食管狭窄 9例 ,胃、十二指肠梗阻 3例。在X线监视下共放置支架 14枚 ,带膜支架 9枚 ,不带膜支架 5枚。结果　 12例患者所有支架均一次安放成功 ,但术后发生的并发症有 :食物嵌顿 3例 ,胸骨后及上腹部痛 4例 ,肿瘤组织或肉芽组织向腔内生长、再狭窄 3例 ,支架滑脱或移位 3例 ,大量出血 (30 0ml以上 ) 2例。结论　内支架置入的确是解决上消化道梗阻的有效方法 ,但术后并发症较多 ,本组病例中发生率亦较高 ,提醒我们要在操作上精确到位 ,并积极对症处理 ,才能降低并发症的发生。     

金属支架置入结合动脉灌注化疗治疗胃、十二指肠恶性梗阻

目的 探讨金属支架置入结合动脉灌注化疗对胃、十二指肠恶性梗阻的疗效.方法 32例胃、十二指肠恶性狭窄患者,梗阻部位位于胃窦及幽门部16例、胃肠吻合口6例、十二指肠降段10例,均在DSA下或结合胃镜经口腔先将导丝放置于胃幽门部及十二指肠梗阻部位,然后置入镍钛合金网状支架于狭窄部位,其中16例术后给予肿瘤供血动脉灌注化疗....     

带膜金属支架治疗高位食管-气管瘘八例报告

目的 应用带膜金属食管支架解决高位食管－气瘘病人的进食呛咳和梗阻问题。方法 根据食管狭窄的程度、长度，普口部位及狭窄上缘距门齿、食管上端开口处的距离，确定支架长度和支架位置，由内镜直视或结合Ｘ线完成操作。结果 ８例病人均１次放置成功，患者呛咳及吞咽困难症状消失，均在３～５d内能进普食，侧位胸片及内镜双重检查，支架位置准 确，形状为两头呈喇叭样，中间狭窄部直径达１．２～１．５cm。结论 内镜直视配合Ｘ     

经肝胃造瘘胃肠道支架成形术

目的探讨病情复杂的胃、十二指肠梗阻的支架成形术的方法及疗效。方法总结分析经口途径较难处理的胃、十二指肠支架成形术病例4例,其中2例Roux-en-Y吻合术后输入段十二指肠恶性梗阻并继发胆道梗阻的患者经肝途径置入支架;1例幽门区恶性狭窄和1例十二指肠降部恶性狭窄患者分别经胃造瘘置入支架。结果所有支架释放成功,患者均在术后第3天开始进流质,无消化道出血等并发症。随访期内均无支架移位及再狭窄。结论掌握技巧,肠道支架成形术在复杂性胃、十二指肠梗阻的治疗是可行的。     

食道恶性狭窄的内支架治疗

目的：探讨用食道内支架技术治疗食道恶性狭窄的疗效、技术要点及并发症。材料和方法：４６ 例中,男４０ 例,女６ 例,年龄５６ ～８０ 岁（ 平均６４ 岁） 。其中食道癌３９ 例,贲门癌２ 例。食道癌或贲门癌术后吻合口肿瘤复发５ 例。选用带膜支架３４ 例,不带膜支架１２ 例。均在Ｘ 线监视下,经口腔植入内支架。结果：４６ 例中４４ 例植入成功。４４ 例植入内支架的患者吞咽困难明显改善。随访６ ～２４ 个月,平均生存期８ 个月,最长２０ 个月。２ 例在２ 个月内肿瘤向腔内生长致再狭窄,再植入内支架症状改善。１ 例内支架植入后２ 个月发生移位,经手术取出,再植入。１ 例内支架植入１ 周后死亡。结论：食道内支架是治疗食道恶性狭窄的有效方法;吻合口或贲门癌所致狭窄以选不带膜支架为佳;配合必要的化、放疗可减少再狭窄,并且可提高生存期。     

内支架治疗贲门癌性狭窄或闭锁的初步研究

目的：探讨内支架治疗贲门癌性狭窄或闭锁的可能性。方法：利用介入放射学方法，以被膜自膨胀式金属内支架植入术，治疗进展期食管下段癌、贲门癌和胃底癌或术后胃—食管吻合口复发癌所引起的严重贲门狭窄或闭锁８例。结果：８例病人８个内支架植入成功，进食困难得到迅速改善。结论：内支架植入治疗贲门癌性狭窄安全而有效，是一项值得推广的新技术。若配合化疗或放疗，将明显改善病人预后。     

金属支架置入治疗上消化道癌性梗阻的临床应用

目的 回顾性分析支架置入治疗上消化道癌性梗阻的方法及并发症的防治. 方法 本组53例上消化道癌性狭窄患者接受金属支架置入治疗.观察治疗效果及并发症情况 . 结果 50例支架1次放置成功,成功率为94.3%.放置支架后患者的一般状况很快好转.并发症有胸痛及异物感、腹泻、支架移位、再狭窄、胃内容物返流、出血.结论对于失去手术机会或拒绝接受手术治疗的上消化道癌性梗阻患者,经口腔放置金属支架是一种操作安全可靠、微创、简单易行、见效快的治疗方法.     

带膜支架在食管狭窄中的临床应用

目的：本文回顾性分析了金属带膜支架对恶性食管狭窄、吻合口狭窄及食管气管瘘和吻合口瘘的治疗功效,方法：36例吞咽困难患者放置了Gianturco-Z和自彭式金属带膜支架。其中包括恶性食管梗阻（32例）、吻合口狭窄（4例）,合并食管气管瘘（3例）和吻合口瘘（1例）。结果：37根支架被成功释放。吞咽困难在33例患者中获得明显缓解,平均吞咽困难积分从3．02减低到0．81。3例食管气管瘘和1例吻合口瘘完全堵住。并发症包括胸骨后疼痛（23例）、支架移位（21例）、上消化道出血（12例）、返流性食道炎（1例）和气管受压迫（1例）。结论：金属带膜支架是治疗食道梗阻、食管气管瘘及吻合口瘘安全、有效的方法。     

Fate of migrated esophageal and gastroduodenal stents: experience in 70 patients

PURPOSE: To investigate the frequency of esophageal and gastroduodenal stent migration and the fate of such stents. MATERIALS AND METHODS: The authors studied five types of covered metal stents. Type A stents were nonretrievable polyurethane-covered stents with shouldered ends (n = 169), type B stents were retrievable polyurethane-covered stents with shouldered ends (n = 62), type C stents were retrievable polyurethane-covered stents with flared ends (n = 72), type D stents were retrievable polytetrafluoroethylene-covered stents with shouldered ends (n = 369), and type E stents were separated stents (n = 216). Types A-D stents were esophageal stents, and the type E stent was a gastroduodenal stent. Stents were placed in 888 patients with either benign (n = 43) or malignant (n = 845) causes of stricture. The rate of stent migration was analyzed relative to completeness of migration, the cause of obstruction, stent type, and stent placement location. The fate of migrated stents and the treatment of patients were evaluated. RESULTS: Stent migration occurred in 70 of the 888 patients (7.9%). Migration occurred in 11 of the 43 patients (25%) with benign cause of strictures and 591 of the 845 patients (7.0%) with malignant cause. The migration rates for types A, B, C, D, and E stents were 10%, 4.8%, 24%, 7.3% and 2.8%, respectively. Of the 70 migrated stents, 45 had complete migration and 25 had partial migration. The anastomotic sites were the areas most commonly associated with migration (16%), but this was not statistically significant. Forty of the 70 migrated stents were removed with retrieval devices under fluoroscopic guidance because they were not passed with stool and possibility of complications related to migrated stents. The remaining 30 stents exited via the rectum (n = 15), remained in the body without complications (n = 12), or were surgically removed because they caused complicated intestinal obstructions (n = 3). CONCLUSION: The overall migration rate for esophageal and gastroduodenal stents was 7.9%. Most migrated stents were removed nonsurgically, exited the body spontaneously, or remained in the body in an uncomplicated state. Surgical stent removal was necessary in three patients (4.3%) due to complicated intestinal obstructions.     

Metallic stents for the treatment of biliary obstruction: A report of 100 cases

The results of the first 100 patients to receive Gianturco-Rösch “Z” stents is presented along with recommendations for their use. The patient population was comprised of 57 men and 43 women, age range 17–85 years (mean 65 years). Fifty-four of the patients had benign obstruction and 46 had malignant obstruction. Of the benign lesions, 11 had sclerosing cholangitis and the remainder had postoperative strictures. Thirty-one of the malignant obstructions were secondary to cholangiocarcinoma with the majority of the others secondary to metastases from various sources. All but one had multiple systems involved. Patients with benign postoperative strictures were all initially treated with balloon angioplasty; if this failed, stents were inserted. In patients who had stents in place for greater than 1 year, the occlusion rate was 13%. The overall occlusion rate in the 43 patients was 7%. Patients with sclerosing cholangitis did less well. In those with sclerosing cholangitis secondary to intraarterial chemotherapy, the occlusion rate was 77%, and we no longer use the metallic “Z” stent in these patients. The stent was not used for malignant common duct obstruction. All patients had hilar involvement. In the patients with malignant obstruction, 17% reobstructed prior to their death. The patients with cholangiocarcinoma did well with a mean survival time of 14 months and a re-obstruction rate of 16%. All late obstructions were secondary to tumor over-growth either proximal or distal to the stents. We conclude that the “Z” stent is an effective form of treatment in patients with benign postoperative strictures and those with malignant obstruction involving the hilum. We do not recommend it as a replacement for conventional stents, but rather as an additional device that allows treatment of some of the more difficult causes of obstruction.     

Primary Percutaneous Treatment of Transplant Ureteral Strictures Using Tandem Stents

PurposeTo evaluate outcomes of primary (first-occurrence) treatment of renal transplant ureteral strictures using tandem parallel internal double-pigtail stents.Materials and MethodsA retrospective electronic chart review, including demographics, medical history, stricture intervention, and outcomes, was performed of patients with renal transplants with first-occurrence ureteral obstructions or leaks reported in a transplant nephrology database over a 4-year period, with a focus on patients treated primarily with tandem stents.ResultsOf 27 patients with first-occurrence ureteral obstruction or ureteral leak, 18 (67%) were treated primarily using tandem internal stents, with 15 (83%) of 18 stent-free for a minimum 90 days of follow-up. There was no significant difference between outcomes for male versus female patients (P>.99) or early versus late strictures (P = .53). Urinary tract infections (UTIs) occurred in 14 (78%) of 18 patients with tandem stents in place. Four patients were hospitalized<48 hours with UTI and sepsis; there were no other major complications.ConclusionsPatients with renal transplants can be successfully managed nonsurgically using tandem ureteral stents for the primary treatment of first-occurrence ureteral stricture. These patients may require more intensive monitoring for UTIs.     

金属内支架治疗直结肠恶性狭窄和梗阻

目的探讨金属内支架治疗直结肠恶性狭窄和梗阻的临床意义和效果。方法47例无手术治疗指征的直、结肠恶性狭窄和梗阻,在X线透视下,经肛门置入镍钛记忆合金网状支架。结果47例患者,共植入镍钛记忆合金网状支架53枚(6例因再次梗阻二次植入支架)。43例支架一次置入成功,占91.5%(43/47),4例经二次支架置入成功,占8.5%(4/47)。2例肿瘤破溃瘘道形成病例,置入覆膜支架成功封堵瘘口。所有病例支架置入后梗阻症状迅速解除,腹胀逐渐消失,可进半流质饮食,一般情况好转。生存6个月以内29.8%(14/47),6个月以上70.2%(33/47),2例已超过13个月,现仍在随访中。结论直结肠金属内支架置入术,是治疗无手术指征的直结肠恶性狭窄和梗阻的首选有效的姑息性治疗手段。     

Fluoroscopically guided placement of a covered self-expandable metallic stent for malignant antroduodenal obstructions: preliminary results in 18 patients

OBJECTIVE: The purpose of this study was to investigate the technical feasibility and the clinical effectiveness of fluoroscopically guided placement of covered self-expandable metallic stents in the treatment of malignant antroduodenal obstructions. SUBJECTS AND METHODS: With fluoroscopic guidance, covered self-expandable metallic stents were placed in 18 consecutive patients with inoperable malignant antroduodenal obstructions. All patients were treated for severe nausea and recurrent vomiting. RESULTS: Stent placement was technically successful in all patients with or without gastrostomy (n = 2) and balloon dilatation (n = 3). After stent placement, symptoms improved in all but one patient, who had another stenosis in the proximal jejunum. During the follow-up of 2-73 weeks (mean, 12 weeks), stent migration occurred in three patients (16.7%) from 1 to 41 days after the procedure. These patients were treated successfully by means of placing a second covered metallic stent. Two patients, who were followed up for longer than 30 weeks, showed a recurrence of strictures because of mechanical failure of the stents; one of the patients was treated with coaxial placement of a second covered metallic stent, which had a positive clinical outcome. CONCLUSION: Fluoroscopically guided placement of covered self-expandable metallic stents is technically feasible and effective for the palliative treatment of inoperable malignant antroduodenal obstructions. The rate of stent migration in our study was lower than those in previous reports.     

覆膜食管支架治疗食管癌放疗后并发食管狭窄及食管瘘的临床效果

 目的 评价覆膜食管支架治疗食管癌放疗后并发食管狭窄或食管瘘的临床效果。方法 回顾性分析58例食管癌放疗后并发食管狭窄及食管瘘的患者,所有患者均在X线监视下放置Z形全覆膜食管支架,分析支架置入的疗效及安全性。结果 58例食管支架均放置成功,术后患者进食恢复通畅、瘘口封闭,各种临床症状得到有效迅速缓解,放置成功率及治疗有效率均为100.0%。术后出现胸痛52例(89.7%),恶心呕吐31例(53.4%),轻度消化道出血21例(36.2%),前两项经对症处理后可有效控制,后者自行好转。结论 采用覆膜食管支架治疗食管癌放疗后并发的食管狭窄及食管瘘简便、安全、疗效确切,值得推广。     

内支架治疗直结肠癌恶性梗阻的临床分析

目的探讨金属内支架治疗直结肠恶性狭窄和梗阻的临床意义和效果。方法50例确诊直结肠癌晚期无手术治疗指征的恶性狭窄和梗阻患者,在X线透视下,经肛门置入镍钛记忆合金网状支架,术后随访2年,观察直结肠癌晚期患者生活质量有无改善。结果50例患者,共植入镍钛记忆合金网状支架56枚（6例因再次梗阻二次植入支架）。44例支架一次置入成功,占88%（44/50）,6例经二次支架置入成功,占12%（6/50）。2例肿瘤破溃瘘道形成,置入覆膜支架成功封堵瘘口。所有患者支架置入后梗阻症状迅速解除,腹胀逐渐消失,可进半流质饮食,一般情况好转。生存6个月以内28%（14/50）,6个月以上68%（34/50）,2例已超过13个月,占4%（2/50）,现仍在随访中。结论直结肠金属内支架置入术,是治疗无手术指征的直结肠恶性狭窄和梗阻的首选姑息性治疗手段,可以有效地提高患者生存质量。