晚期食管癌带膜记忆合金支架植入术的并发症防治

目的探讨晚期食管癌带膜记忆合金支架植入的并发症及其防治措施。方法应用带膜记忆合金支架治疗晚期食管癌117例，其中76例术前检查发现失去手术机会，6例食管癌放疗、化疗或术后吻合口复发，2例食管癌合并食管气管瘘，采用介入法放置支架；33例尚有手术探查指征，术中见肿瘤无法手术切除而于术中放置支架。观察近、远期并发症，并给予相应处理。结果117例患者植入支架131支，其中14例放置2枚支架。全组无手术死亡病例。近期并发症发生率为40．2％(47／117)，其中33例胸部膨胀感、钝痛，2例室性心律失常，5例支架移位，7例出血。远期并发症发生率为18．6％(11／59)，其中2例支架内食物堵塞，4例出血，5例肿瘤生长超过支架上端而再狭窄。除1例术后12天大呕血死亡外，其余均采取相应措施处理成功。结论降低晚期食管癌带膜记忆合金支架植入并发症必须采取术前、术中和术后的综合防治措施。     

应用带膜镍钛记忆合金支架治疗晚期食管癌

目的总结应用带膜镍钛记忆合金支架治疗晚期食管癌的临床经验。方法53例晚期食管癌患者在食管X线钡餐透视下采用介入法、内镜法或术中植入法在食管内放置带膜镍钛记忆合金支架。术后进食困难程度用Neuhaus分级评估，并随访观察所有患者近期和远期疗效。结果所有患者支架均一次放置成功，无操作引起的严重并发症，术后患者吞咽困难症状明显改善，置入支架后患者吞咽困难分级较置入支架前明显降低（P〈0．01），能顺利进半流质或普通食物。狭窄食管段直径由2～4mm扩张至16～20mm。随访49例（92．5%），随访时间3～24个月。术后近期并发症主要为胸骨后异物感、疼痛、恶心和少量消化道出血，发生率为96．2％（51／5a）。26例患者（53．1％，26／49）于术后3～15个月内死亡，平均生存7．8个月，死亡原因多为肿瘤转移、全身衰竭。结论食管内放置带膜镍钛记忆合金支架治疗晚期食管癌患者的食管狭窄、食管瘘简单易行、损伤小，近期疗效明显，是一种有效的姑息性非手术治疗方法。     

应用带膜支架治疗晚期食管癌贲门癌

目的　探讨置入国产CZES型自膨式带膜支架 ,结合其它疗法综合施治重症晚期食管癌贲门癌病人的疗效。方法　采用内镜法、介入法、混合法、手术法 ,为晚期食管癌、贲门癌、食管瘘、吻合口漏、吻合口癌复发或吻合口狭窄病人 15 1例 ,共置入 15 9个支架 ,继而 132例实施放、化疗和中药综合施治。结果　疗效满意 ,明显改善了病人生活质量 ,体质增强 ,进食困难分级由 3.12级降至 1.0 5级 ,肿瘤缩小 2 2～ 3 4cm ,体重增加 1～ 6kg ,置入支架后生存 1 5～ 36个月。结论　置入支架结合综合施治行之有效 ,操作简便、安全可靠 ,适用于临床 ,易于推广     

颈动脉支架植入术并发症分析

目的 总结颈动脉球囊扩张及支架植入术(carotid artery stenting,CAS)治疗颈动脉狭窄术后并发症及处理措施.方法 回顾性分析2006年7月至2012年1月因颈动脉狭窄而接受颈动脉球囊扩张及支架植入术(carotid artery stenting)72例患者的临床资料.CAS操作采取标准治疗方法,患者术前5d均口服阿司匹林100 mg与氯吡格雷75 mg,所有患者均先放置远端保护装置,90％以上狭窄患者进行前扩张,残留狭窄＞30％则进行后扩张.结果 72例患者成功地植入颈动脉自膨式支架80枚,全部使用远端脑保护装置,5例患者行同期手术,其中冠状动脉搭桥手术( off-pumpcoronary artery bypass grafting,OPCABG)2例,左锁骨下动脉支架植入2例,1例肾动脉支架植入.住院期间并发症的发生率为37.5％(27例),其中严重并发症(死亡/卒中/心肌梗死)发生率为1.39％(1例同侧小卒中);其他神经系统并发症包括2例同侧TIA(2.78％),1例高灌注综合征(1.39％),血液动力学不稳定并发症的发生率为29.2％(21例),其中1例高血压(1.39％),5例心动过缓(8.33％),15例术后低血压(20.8％),其他2例出现穿刺点血肿(2.78％).结论 血液动力学改变(低血压、心动过缓)是CAS围手术期主要并发症,神经系统并发症发生率较低,严重并发症少见.     

带膜记忆合金支架置入术治疗恶性食管狭窄的临床应用

目的:总结食管带膜支架置入术治疗恶性食管狭窄、食管气管瘘及食管纵隔瘘的临床应用.材料和方法:恶性食管狭窄15例,其中合并食管气管瘘或食管纵隔瘘4例,全部病例均在电视透视监视下完成操作.结果:本组病例均一次性顺利完成支架置放,其中1例关年后再狭窄置入第2枚支架.结论:食管带膜支架置入术是治疗手术无能的食管恶性狭窄的有效方法,对延长患者生存期及提高患者生存期生活质量起到了里示著作用,手术操作安全、适用.     

带膜食管支架置入后的远期疗效及并发症

我院自 1996年 4月至 2 0 0 0年 4月对 31例各种原因造成的食管狭窄 ,6例食管呼吸道瘘 ,1例化学灼伤患者放置了带膜食管支架。其中 36例有较为完整的随访资料 ,现报道如下。1.临床资料与方法 :本组男 2 1例 ,女 15例。年龄 5 2 0岁～ 6 7 0岁 ,平均5 7 5岁。其中食管癌或贲门癌术后单纯吻合口狭窄 2 4例 ,吻合口复发癌 3例 ,食管呼吸道瘘 6例[1] ,晚期食管癌 2例 ,化学灼伤 1例。本组患者均在咽部表面麻醉后 ,在Ｘ线监视下 ,经口放置带膜食管支架。支架直径 1 5～ 3 2ｃｍ ,长度 6 0～ 12 0ｃｍ。伴有食管明显狭窄者 ,先行气囊导管扩张术…     

带膜网状食管支架治疗食管狭窄43例临床应用体会

1 资料和方法 1.1 临床资料 本组43例,年龄42～70岁,平均53.2岁。其中食管癌36例,食管胃吻合口狭窄6例,贲门失弛缓症手术治疗失败1例。全部病例置人食管支架前均出现明显梗阻症状,有8例滴水未进8～16天。43例置入带膜网状食管支架均获成功,进食恢复通畅,观察时     

带膜食管癌支架置入术后护理

随着食管支架的材料、形状的不断改进,为许多不能手术切除或手术切除后吻合口狭窄进食困难的患者,解决了患者的进食及营养问题.提高了生存质量.     

食管带膜支架治疗食管癌术后食管—气管漏

<正>食管癌晚期合并食管-气管漏,临床治疗非常困难,我们于1998年10月~2003年12月,用国产食管带膜支架置入食管治疗食管癌术后晚期食管-气管漏8例,取得了较为满意的效果,现报告如下:     

A newly-designed shape-memory coil stent for esophageal stricture: A preliminary report

A newly designed coil esophageal endoprosthesis was developed using a thermal shape-memory titanium-nickel alloy. The major advantages of this stent lie in (a) its small diameter while in its compressed state in ice water and (b) the large lumen which is achieved once it has been warmed to body temperature. The technical feasibility and tissue compatibility of this stent were tested on four beagle dogs: two with an anastomotic stricture and two with a stenosis induced by the injection of monoethanolamine oleate. The teflon-coated stent was inserted under fluoroscopy and removed 4 weeks after implantation. No signs of esophageal reobstruction were observed in any of the animals after implantation or extraction of the stent, although the dog which had received the first stent without teflon coating developed obstruction caused by granulation tissue. Our preliminary experience strongly suggests that the shape-memory alloy stent with teflon coating may be used in the endoscopic treatment of anastomotic stenosis after esophagectomy, as well as of esophageal obstruction caused by carcinoma.     

The use of retrievable fully covered self-expanding metal stent in refractory postoperative restenosis of benign esophageal stricture in children

Purpose

This study analyzes the efficacy and safety of a retrievable, fully covered self-expanding metal stent (cSEMS) in the treatment of refractory benign esophageal restenosis in children.

Methods

This is a retrospective analysis of the application of a newly designed cSEMS in treating refractory benign postoperative restenosis in five children with ages ranging from 16 months to 8 years. Efficacy and safety were evaluated during the follow-up period.

Results

cSEMS with or without an antireflux valve at the distal end were successfully placed and removed in five children. These five patients were followed up for 4–12 months after stent removal. Among the five patients, ulcerative stricture was observed in two patients because of reflux esophagitis, while three patients showed no signs of stricture recurrence. Stent migration was observed in three patients, two of which required the stent to be reset. The narrow esophagus was successfully expended to a diameter of 12–13 mm. Besides the observation of mild granulation tissue growth in one case, no severe complications were observed during surgery and after stent placement.

Conclusion

Our study suggests that a retrievable, fully covered SEMS is safe and partially effective for treating refractory benign postoperative esophageal restenosis in children during short-term observation.     

125I内照射联合金属内支架治疗恶性食管狭窄的临床研究

目的探讨125I粒子与内支架结合治疗食管恶性狭窄的可行性及相关疗效。方法本组16例食管恶性狭窄的患者,临床分级为3~4期,在X线透视下经口腔将125I粒子联合内支架植入到患者食管内狭窄段进行治疗,术后随访并发症及疗效。结果16例患者125I粒子联合内支架植入均顺利释放,释放过程中未出现放射粒子脱落现象;所有患者术后吞咽困难症状消除或明显缓解,无明显并发症。结论125I内照射联合金属内支架治疗食管恶性狭窄,是一种安全、可行和有效的方法。     

The use of a retrievable self-expanding stent in treating childhood benign esophageal strictures

Background/Purpose

Esophageal stenting is a popular form of treatment of esophageal strictures in adults but is not widely used in children. The aim of the current study was to investigate whether esophageal stents could be used safely and effectively in the treatment of esophageal stenosis in children.

Methods

Covered retrievable expandable nitinol stents were placed in 8 children with corrosive esophageal stenosis. The stents were removed 1 to 4 weeks after insertion.

Results

The stents were placed in all patients without complications and were later removed successfully. After stent placement, all patients could take solid food without dysphagia. Stent migration occurred in one patient and so the insertion procedure was repeated to reposition the stent. During the 3-month follow-up period after stent removal, all children could eat satisfactorily. After 6 months, 2 children required balloon dilation (3 times in one and 5 times in the other). The dysphagia score improved in all patients.

Conclusions

The use of the covered retrievable expandable stent is an effective and safe method in treating childhood corrosive esophageal stenosis.     

Efficacy and safety of Palmaz stent insertion in the treatment of renal artery stenosis in kidney transplantation

Abstract The aim of this study was to verify the safety and long‐term efficacy of Palmaz stent insertion in the treatment of transplant renal artery stenosis (TRAS) in kidney transplantation. Nine of our transplanted patients were submitted to Palmaz stent insertion because of recurrence of renal artery stenosis after previous percutaneous transluminal angioplasty or because of severe ostial stenosis. The post‐stenting results were excellent in all patients, with a follow‐up period ranging from 1 to 3 years. The mean blood pressure (one‐third systolic pressure plus two‐thirds diastolic pressure) fell from 118.11 ± 7.44 to 103.21 ± 9.25 mm Hg; P < 0.001. Renal artery peak blood flow velocity as determined by Doppler sonography fell from 352 ± 73.24 cm/s to 169.8 ± 23.35 cm/s; P < 0.001. The serum creatinine 1‐year after stenting was 1.3 ± 0.3 mg/dl with a slight reduction with respect to the prestenting values (1.5 ± 0.3 mg/dl; NS). As no complication occurred, we conclude that insertion of the Palmaz stent is a safe and effective way to treat recurrence of artery stenosis or ostial stenosis in renal transplanted patients.     

覆膜支架在中晚期食管癌的应用53例

目的评价覆膜支架应用于中晚期不能切除的食管癌性狭窄的姑息治疗效果。方法进食困难的中晚期食管癌患者53例(其中8例为食管气管瘘),在X线透视下进行支架置入治疗,并随访6个月～1年。结果53例全部成功置入了被覆金属支架,术后病人的进食状况明显改善,生活质量有不同程度提高。结论置入食管被覆支架治疗中晚期食管癌性梗阻是一种安全、有效的姑息性治疗方法。     

应用自膨式支架置入治疗颈动脉狭窄

目的　探索颈动脉狭窄的治疗方法。　方法　应用 14枚自膨式支架血管内置入治疗 9例有症状颈动脉狭窄患者的 10处病变 ,狭窄程度 70 % -95 %。　结果　治疗后短暂性脑缺血发作 (TIA)消失 ,残余狭窄均 <5 0 %。无症状脑梗塞 1例。无死亡。　结论　应用自膨式支架血管内置入是治疗颈动脉狭窄是一种安全有效的方法     

Nitinol stent for the treatment of tracheobronchial stenosis

OBJECTIVE: The purpose of this study was to evaluate the potential utility of implantation of a nickel-titanium alloy (nitinol) stent for the treatment of malignant or benign tracheobronchial stenosis. METHODS: We evaluated 18 patients (14 men and 4 women) who received 24 nitinol stents, between November 1997 and May 2000. All 18 patients had severe dyspnea caused by tracheobronchial stenosis. The underlying condition was malignant disease in 15 patients, and benign tracheal collapse in the other 3 patients. RESULTS: Implantation of the stent was successfully performed in all patients. Seventeen patients experienced immediate clinical improvement in respiratory symptoms. The remaining 1 patient with a bronchial fistule after lobectomy did not benefit, and died of pneumonia at 16 days after the implantation. In 15 patients, the procedure was performed using a flexible bronchoscope under local anesthesia alone, while the remaining 3 patients needed intravenous sedation. There was no complication resulting from the stent implantation. Among the 3 patients with benign tracheal collapse, 2 patients were alive at 746 and at 401 days after the stent implantation, at the time of this report. One patient with cicatricial stenosis after intubation died of heart failure due to previous myocardial infarction. Among the 15 patients with malignant disease, 4 patients have survived for 177 to 305 days to date, while the other 11 patients have died of primary malignancy with a mean survival duration of 60.2 days. CONCLUSION: The nitinol stent was effective in treating malignant or benign tracheobronchial stenosis, and had some remarkable advantages compared with other tracheobronchial stents. In stenting, most procedures can be performed using flexible bronchoscope under local anesthesia.     

New indications in the treatment of advanced esophageal cancer using self-expanding stent

In the past four years we performed palliative reconstruction in 69 patients with Tygon or Polyflex self-expanding stents. The procedure was performed in 35 patients because of mid-third oesophageal cancer, in 18 patients because of cancer of the cardia, in 7 patients because of mediastinal tumour and in 8 patients because of oesophago-respiratory fistula. The procedures improved the swallowing greatly, the oesophago-respiratory fistulae closed. During endoscopic intubation of cardia tumours the risk of perforation is high, while it is lower in case of open operative pull-through method. Insertion of Polyflex self-expanding stent under X-ray is safe. Improvement of the stents helps not only safer use, but it encourages its use in new indications, such as iatrogen benign perforation, corrosive oesophageal stricture, long preoperative period, when the swallowing for better nutrition is essential. The procedures improve the quality of life and improve survival time because of the restored swallowing, closed oesophago-respiratory fistula with the prevention of aspiration.