国产记忆合金支架治疗食管狭窄

为开辟治疗食管狭窄的新途径，应用国产ＴｉＮｉ记忆合金支架治疗食管良恶性狭窄患者１８例次。支架置放均一次成功，支撑效果好，术后吞咽通畅。国产记忆合金支架为食管良恶性狭窄的治疗提供了一种快速简便、安全有效的方法，价格仅为进口支架的１／１０，为临床应用推广提供了有利条件。     

记忆合金支架治疗食管狭窄

记忆合金支架治疗食管狭窄王振华，高晋华，徐采朴我科１９９３年３月开始应用镍钛形状记忆合金（记忆合金）食管支架治疗食管狭窄，取得良好效果。现将初步结果报告如下。１．一般资料：１９９３年３月至１９９５年１月共治疗８例１１例次。年龄４２至６２岁，均为男性。...     

带膜记忆合金支架治疗食管贲门良恶性狭窄30例

自１９９７０８以来，我们对具有严重吞咽困难的３０例食管贲门良恶性狭窄患者通过植入带膜记忆合金支架进行治疗，取得较好效果，现报道如下．１材料和方法１．１材料本治疗组患者共３０例，其中男１２例，女１８例，年龄１６岁～７８岁，平均６４岁，病程２０ｄ～１０...     

记忆合金支架治疗食管贲门癌性狭窄43例

记忆合金支架治疗食管贲门癌性狭窄４３例王国华许法根张玉吴旦徐玉玉江苏省常州市戚墅堰铁路医院消化内科２１３０１１ＳｕｂｊｅｃｔｈｅａｄｉｎｇｓＥｓｏｐｈａｇｅａｌｎｅｏｐｌａｓｍｓ／ｃｏｍｐｌｉｃａｔｉｏｎＥｓｏｐｈａｇｅａｌｓｔｅｎｏｓｉｓ／ｔｈ...     

非X线下放置国产记忆合金支架治疗食管贲门癌性狭窄

１９９６年９月至１９９８年７月 ,我院对７０例食管贲门癌及术后吻合口高度狭窄患者行内镜下支架治疗 ,取得满意效果 ,现报告如下。１．临床资料 :本组７０例中 ,男５４例 ,女１６例 ,年龄３６～７８岁 ,平均６２岁。其中２例贲门癌狭窄支架置入后分别于６个月和９个月肿瘤蔓延支架上口引起狭窄 ,进行第二次置入支架治疗。患者以吞咽困难为主诉 ,根据吞咽困难程度 ,以Ｓｔｏｏｌｅｒ分级 :Ⅳ级２３例 ,Ⅲ级４２例 ,Ⅱ级５例。狭窄原因晚期食管癌２９例 ,食管癌术后狭窄５例 ,食管气管瘘４例 ,贲门癌２３例 ,贲门癌术后复发吻合口狭窄９例 ,…     

记忆合金支架治疗食管贲门狭窄38例

目的探讨国产记忆合金支架在食管责门良、恶性狭窄的作用．方法在内镜及监视器直视下应用Savary锥形硅胶管扩张后国产记忆合金支架治疗食管贲门狭窄38例，43枚支架．结果38例43枚支架一次置入成功率100％，按Stooler分级，治疗前4级31例，3级7例；治疗后0级5例，1级18例，2级15例，生活质量明显改善，术后当日即可进食．术后有不同程度胸痛，少数恶心呕吐，3例病变上方梗阻复发，在原支架上方又置入一枚支架，2例镜下置放带膜支架一枚．随访置管时间最长达27mo，2例因肝转移死亡，无1例因直接进食障碍而死亡，未发现支架移位及脱落．结论内镜直视下应用锥形硅胶扩张管扩张后置入记忆合金支架，操作安全简便，姑息效果好，并发症少，可明显改善患者的生活质量，提高生存时间．     

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...     

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。     

记忆合金支架与局部注药联合治疗食管狭窄

１９９７年２月开始至今,我们对无手术适应证的晚期食管、贲门癌及术后食管狭窄者,在内镜下安置记忆合金支架治疗,部分患者置入后经内镜在肿物内直接注射化疗药物,收到了良好的效果。现报告如下。一、临床资料　３２例患者中,男２６例,女６例,平均年龄６６岁（３５～７３岁）。根据吞咽困难的程度将其分为４级,不能进食为０级,进流食的１级,进半流食为２级,进普食为３级。１６例０级,１５例１级,１例２级,平均０．５３±０．４１级。狭窄原因：食管癌１９例,手术后１２例,其中４例术后复发,８例吻合口瘢痕性狭窄,放疗２例…     

COVERED WALLSTENT FOR PALLIATION OF MALIGNANT COMMON BILE DUCT STRICTURE: PROSPECTIVE MULTICENTER EVALUATION

Background: Occlusion due to tumor ingrowth is a major drawback in self‐expandable metallic stents. Covering the stent is a probable solution to prevent tumor ingrowth. A manufactured covered self‐expandable metallic stent, Covered Wallstent, has become commercially available. We evaluated the Covered Wallstent in a prospective uncontrolled multicenter setting. Methods: Between October 2001 and October 2003, 97 patients with common bile duct strictures deemed unfit for surgical resection underwent placement of a single Covered Wallstent, and were followed prospectively until April 2004. Results: Placement of the stent was successful in all the patients attempted. As a procedure‐related complication, acute pancreatitis developed in four patients, in one of whom obstruction of the pancreatic duct orifice with the stent body seemed to be a major cause. The 30‐day mortality was 9.3% (nine patients). Stent occlusion occurred in 22 patients as a late (greater than 30 days) complication, due to either tumor overgrowth (14 patients) or encrustation (eight patients). Distal migration of the stent was demonstrated in two other patients. No stent occlusions due to tumor ingrowth were observed. Patency rates of the stent for 3‐, 6‐, and 12‐month periods were, respectively, 90.7, 82.5, and 45.9%. Conclusions: The present results in a large series suggest that placement of the Covered Wallstent is feasible and effective in the palliation of patients with malignant common bile duct strictures. The Covered Wallstent seems to be reliable in eliminating tumor ingrowth. The role of stent covering in promoting stent function should be examined in a prospective comparative study between covered‐ and uncovered Wallstents.     

TREATMENT STRATEGIES FOR ESOPHAGEAL STRICTURE BEFORE OR AFTER CHEMORADIOTHERAPY FOR ADVANCED ESOPHAGEAL CANCER

Esophageal stricture due to advanced cancer is one of the serious complications of esophageal cancer as it causes dysphagia. A self‐expandable metallic stent is easily inserted in such patients and provides immediate symptomatic relief of dysphagia. Alternatively, definitive chemoradiotherapy has demonstrated a significant improvement in local control and overall survival, and is now commonly used for not only unresectable esophageal cancer patients but also in resectable cases. However, little is known about its role in relief of dysphagia. Therefore, we reviewed our experience of patients with esophageal stricture who were treated with chemoradiotherapy. We expect that the findings in this article might be useful in future clinical practice.     

BILIARY STENTING FOR MALIGNANT STRICTURE OF THE BILE DUCT

Biliary stenting is used as a standard procedure for the relief of jaundice in patients with non‐resectable malignant stricture of the bile duct. The stents available in the market are variously characterized, and surgeons must select an appropriate one for each disease status. For the stricture of the middle and/or lower part of the bile duct, covered metallic stent is superior to plastic stent in the patency period, however, there are questions as to the use of metallic stents in light of cost‐effectiveness and development of complications of stenting. And, the stent selection for the stricture of the hilar part of the bile duct has not been fully studied, which remains a problem yet to be resolved. In the use of metallic stent, it is difficult to manage when stent occlusion or complication occurs, and it holds the risk of developing a very serious complication. In the use of plastic stent, however, long‐term patency cannot be expected, which is also a problem yet to be resolved.     

食管狭窄扩张结合抗返流的远期疗效评价

８名贲门切除吻合术患者均显示食管内有明显的核素返流。对３４名食管狭窄进行了７２次扩张，并结合抗返流治疗。结果表明：（１）９１．２％狭窄解除，近期（１０天内）进食计分（０～３）从扩张前的１．１８±０．７５增至２．５９±０．６６（Ｐ＜０．００１）；远期（平均１９个月）进食计分为２．３１±０．７０，仍明显高于扩张前（Ｐ＜０．０１）。（２）８例局部注射激素，２个月后进食计分为２．５±０．５，而１９例对照组为２．１±０．５。（３）平均扩张次数为２．１±１．１次。除１例扩张后并发出血外无其它并发症。     

METAL STENTS FOR PALLIATION OF INOPERABLE CARCINOMA OF THE GASTROINTESTINAL TRACTS

Recently, various self‐expandable metal stents (SEMS) have been developed for palliation of malignant obstruction of gastrointestinal tract. Although they have not been approved for use in benign disease, there are specific clinical indications for which expandable metal stents may be beneficial. This article reviews the use of self‐expandable metal stents for malignant gastrointestinal obstruction and the use of SEMS specially developed for unusual stenting such as antimigration and antireflux mechanism.     

SELF‐EXPANDABLE METALLIC STENT FOR PATIENTS WITH NON‐RESECTABLE MALIGNANT COLORECTAL STRICTURE: REVIEW OF 102 CASES IN THE JAPANESE LITERATURE

Alternative procedures using endoscopy have been developed, one of which is treatment with self‐expandable metallic stents (SEMS). In Japan, as SEMS for colorectal stricture has not been approved by the public insurance system, esophageal stent is used for colon and rectum exceptionally as a colonic SEMS after obtaining informed consent from the patient. This situation is very different to other countries. In the present study, we review the Japanese medical literature to determine the current status, feasibility, and challenges remaining for SEMS to show the current status of SEMS usage for colonic strictures in Japan. We investigated SEMS for patients with non‐resectable malignant colorectal stricture in 102 Japanese case reports. Primary colorectal cancer comprised half of the cases. The insertion success rate was 100% and the clinical effectiveness rate was 93%. Restricture occurred in 12 cases (12%), and half of those cases were treated by stent in stent. Stent migration occurred in eight cases (8%) and perforation in two cases (2%). The range of SEMS insertion duration was 1 to 576 days (mean: 132 days, median 142 days). There were no deaths related to the procedure. This procedure allows patients to forgo colostomy and is cheap, safe and effective, with a short treatment time. This procedure is a viable palliative alternative to colostomy for patients with inoperative malignant colorectal stricture. Widespread application of the procedure has been hampered.     

SUCCESSFUL TREATMENT USING A SELF‐EXPANDABLE METALLIC STENT IN THE PALLIATION FOR UNRESECTABLE MALIGNANT OBSTRUCTION OF THE COLON AND RECTUM

Background: We attempted the placement of a self‐expandable metallic stent (SEMS) for unresectable malignant obstruction of the proximal colon as well as obstruction of the distal colon and rectum, using a technical device. Patients and methods: Thirty patients were selected to place SEMS. The procedure was performed under endoscopic and fluoroscopic guidance. As a technical device, we used an angiographic introducer to straighten the rectosigmoid region. Moreover, we used a transparent hood to easily obtain a front view of the stricture. Results: Of 30 cases of attempted SEMS placement, SEMS was successfully placed in 26 (87%). The technical success rate was 82% (9/11) in strictures of the proximal colon, while it was 89% (17/19) in those of the distal colon or rectum. According to complications, stent migration occurred in one patient (3%) and restenosis was also observed in one patient (3%). Conclusion: Placement of SEMS is a feasible and effective adjunct and alternative to stoma in malignant large bowel obstruction.     

TEMPORARY USE OF A NEW FULLY‐COVERED SELF‐EXPANDING METAL STENT FOR THE MANAGEMENT OF POST‐ESOPHAGECTOMY STRICTURES

Perioperative morbidity rates following esophagectomy for esophageal cancer remain quite high (26–41%) even at high‐volume centers. Complications may include stricture at the esophagogastric (EG) anastomosis, as well as tracheo‐esophageal or tracheo‐gastric fistula formation. Fully‐covered self‐expanding metal stents (FCSEMS) have only recently been described for use in benign esophageal disease. The use of FCSEMS for the management of postoperative complications following esophagectomy has not been well studied. We report our observations in three consecutive patients that underwent placement and subsequent removal of a new, fully‐covered metal stent (Wallflex^® esophageal stent) for treatment of dysphagia due to a persistent stricture at the EG anastomosis.