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1.
The purpose of this study was to evaluate the effectiveness of temporary metallic stenting in 55 patients with treatment-resistant
benign esophageal strictures and to identify factors associated with clinical outcomes. Under fluoroscopic guidance, covered
retrievable stents were placed in 55 patients with benign esophageal strictures and were removed with retrieval hook 1 week
to 6 months after placement. Stent placement was successful in all patients, and the mean dysphagia score was reduced from
2.8 to 1.3 (p < 0.001). The most common complications were tissue hyperproliferation (31%), severe pain (24%), and stent migration
(25%). During follow-up (mean: 38 months), recurrence of the stricture necessitating balloon dilation was seen in 38 (69%)
of 55 patients. Maintained patency rates after temporary stenting at 1, 3, and 6 months and 1, 2, and 4 years were 58%, 43%,
38%, 33%, 26%, and 21%, respectively. In multivariate analysis, length (p = 0.003) of the stricture was the only significant factor associated with maintained patency after temporary stenting. In
conclusion, temporary metallic stenting for refractory benign esophageal strictures may be effective during the period of
stent placement, but is disadvantaged by the high recurrence rates after stent removal, particularly in patients with a long
length of stricture (>7 cm). 相似文献
2.
食管内支架置入后的随访研究 总被引:84,自引:5,他引:79
目的食管狭窄置入金属支架后长期随访,观察其疗效和并发症。方法43例食管狭窄放置了金属支架患者有较完整的随访资料。良性狭窄14例,恶性狭窄29例。置入Ultreflex支架32例,GianturcoZ型带膜支架4例,国产网状支架6例,Walstent支架1例。门诊随访行食管造影和内窥镜检查27例,电话或信访16例。结果1~32个月随访观察,无支架移位。24例死亡,术后生存时间17天至28个月,平均6.8个月。死亡原因:肿瘤广泛转移19例,肺部感染2例,其他原因引起死亡3例。发生再狭窄16例,为支架内或两端发生狭窄。肿瘤组织生长造成的狭窄4例,12例为食管腔内组织过度增生,这类狭窄全部发生在置入支架后4~5个月。支架内狭窄5例,支架两端狭窄11例,其中10例为支架上端狭窄。12例行再次球囊扩张或支架置入。结论肿瘤的生长,特别是粘膜和纤维组织增生是引起再狭窄的主要原因,支架上端狭窄更容易发生吞咽困难。由于再狭窄的发生率较高,对于良性食管狭窄的支架成型术应严格选择病例。 相似文献
3.
The purpose of this study was to determine the efficacy of the uncovered coil stents in patients with malignant dysphagia.
Coiled spring-shaped uncovered self-expanding metallic Esophacoil stents (Instent, Eden Prairie, Minnesota) were placed in
11 patients (9 men and 2 women; age range 38–77 years, mean age 60.5 years) with malignant esophageal strictures and dysphagia,
under fluoroscopic guidance. Dysphagia was graded on a scale of 0 to 4 (0 = no dysphagia; 1 = dysphagia to normal solids;
2 = dysphagia to soft solids; 3 = dysphagia to solids and liquids; 4 = complete dysphagia, inability to swallow saliva). Two
patients had received radiation therapy, 4 had had chemotherapy, and 5 had had a combination of both radiation and chemotherapy
before stent palliation. Control clinical examinations and endoscopic or barium swallow studies were performed every 4 weeks
until the patient died. The stents were well tolerated by all patients and were effective in 9 of 11 patients with malignant
dysphagia. Complications of the procedure included incomplete opening of the stent in 1 case, migration in 1 case, transient
pain in 8 cases, reflux in 3 cases and minor gastrointestinal bleeding in 2 cases. Stent migration in 1 case resulted in surgical
intervention and incomplete opening of the stent allowed only partial improvement of dysphagia in 1 case. The quality of life
significantly improved in all other patients. Mean survival time of the patients was 73 days (range 34–125 days) and no significant
tumor ingrowth was detected during the follow-up period. Insertion of an Esophacoil has a good palliative effect on dysphagia
in patients with malignant esophageal strictures with few complications. Although the stent is uncovered, tumor ingrowth and
overgrowth were not observed in our study, possibly because of previous treatments.
Received: 22 July 1998; Revision received: 30 November 1998; Accepted: 21 December 1998 相似文献
4.
Self-expanding oesophageal metal stents for the palliation of dysphagia due to extrinsic compression
The role of self-expanding metallic stents is well established in the palliation of oesophageal stenosis and dysphagia due
to primary oesophageal malignancy. However, their role in palliation of dysphagia due to external compressive mediastinal
malignancies is not well established. The purpose of this study was to assess the efficacy of self-expanding metallic stents
in the palliation of dysphagia due to extrinsic oesophageal compression by mediastinal malignancy. Between January 1995 and
January 1998, 21 patients with oesophageal compression due to malignant mediastinal tumours underwent oesophageal stent placement
for palliation of dysphagia. Complete data were available in 17 patients (10 men and 7 women). The mean age was 63.5 years
(range 46–89 years). A total of 19 stents were placed successfully. The dysphagia grade prior to and after oesophageal stent
placement was assessed and the complications documented. Of the 17 patients, 16 reported an improvement in dysphagia. The
mean dysphagia score improved from 3.1 prior to treatment to 1.3 after treatment. In 1 patient the stent slipped during placement
and another stent was placed satisfactorily. Early complications (within 48 h) in the form of mild to moderate retrosternal
chest pain occurred in 5 patients. This was treated symptomatically. Late complications (after 48 h) in the form of bolus
impaction occurred in 2 patients. This was successfully treated with oesophagoscopy and removal of bolus. In 2 patients the
stent was overgrown by tumour and in one of these an additional stent was placed. In 1 patient incomplete closure of a tracheo-oesophageal
fistula was observed. There was no procedure- or stent-related mortality. The mean survival time of this group was 2.1 months.
Self-expanding metallic stents can be safely and effectively used in the palliation of dysphagia due to external mediastinal
malignancies.
Received: 21 October 1998; Revised: 1 February 1999; Accepted: 4 February 1999 相似文献
5.
Ko GY Song HY Hong HJ Sung KB Seo TS Yoon HK 《Cardiovascular and interventional radiology》2003,26(2):141-145
Purpose: To assess the efficacy of
balloon dilation combined with chemotherapy and/or radiation therapy
for palliation of dysphagia due to malignant esophagogastric junction
strictures.
Methods: Fluoroscopically guided balloon
dilation was attempted in 20 patients. The causes of strictures were
gastric adenocarcinoma (n = 10) and esophageal squamous
cell carcinoma (n = 10). Scheduled chemotherapy and/or
radiation therapy followed balloon dilation in all patients.
Results: There were no technical failures or major
complications. After balloon dilation, 15 (75%) patients showed
improvement of dysphagia. No patient complained of reflux esophagitis
during the follow-up period. Among the 15 patients, seven needed no
further treatment for palliation of dysphagia until their deaths. The
remaining eight patients underwent repeat balloon dilation
(n = 4) or stent placement (n = 4)
3–43 weeks (mean 15 weeks) after the initial balloon dilation because
of recurrent dysphagia.
Conclusion: Balloon dilation
combined with chemotherapy and/or radiation therapy seems to be an easy
and reasonably effective palliative treatment for malignant
esophagogastric strictures. 相似文献
6.
I. Kaare Tesdal Werner Jaschke Mathias Bühler Ralf Adamus Thomas Filser Eggert Holm Max Georgi 《Cardiovascular and interventional radiology》1997,20(1):29-37
Purpose To evaluate prospectively our experience with transjugular intrahepatic portosystemic shunt (TIPS) using four different metallic
stents.
Methods Between November 1991 and April 1995, 57 patients (41 men and 16 women; age 35–72 years, mean 54 years) underwent the TIPS
procedure. Techniques for portal vein localization before and during TIPS were fluoroscopy, computed tomography (CT) studies,
wedged hepatic venography, arterial portography, and ultrasound. After predilation we deployed balloon-expandable (n=48) and self-expanding (n=45) metallic stents. Fifteen patients underwent variceal embolization. Initial follow-up angiograms (mean 6.9 months, range
3–24 months) were obtained in 39 of these patients.
Results Fifty-three patients (93%) had successful TIPS placement. The mean decrease in portal pressure was 42.7%. Besides fluoroscopy,
the most helpful techniques for portal vein localization were venography and CT. Residual stenosis (n=1) and late shortening (n=4) of Wallstents resulted in shunt dysfunction. The technical problems encountered with the Palmaz stent resulted from its
lack of flexibility. We combined balloon-expandable and self-expanding stents in 12 patients. The 30-day and late follow-up
(mean 11.9 months) percutaneous reintervention rates were 11.3% and 64.2%, respectively. There were no clinically significant
complications related to the TIPS insertions.
Conclusion An ideal stent does not exist for TIPS, and the authors recommend combining a Palmaz stent with a flexible self-expanding
stent. 相似文献
7.
食管支架治疗食管良恶性狭窄:附23例分析 总被引:78,自引:4,他引:74
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%。 相似文献
8.
Gutzeit A Binkert CA Schoch E Sautter T Jost R Zollikofer CL 《Cardiovascular and interventional radiology》2009,32(1):97-105
Purpose: To retrospectively evaluate the clinical effectiveness of a self-expanding uncovered Wallstent in patients with malignant
gastroduodenal obstruction. Materials and Methods: Under combined endoscopic and fluoroscopic guidance, 29 patients with a malignant gastroduodenal stenosis were treated with
a self-expanding uncovered metallic Wallstent. A dysphagia score was assessed before and after the intervention to measure
the success of this palliative therapy. The dysphagia score ranged between grade 0 to grade 4: grade 0 = able to tolerate
solid food, grade 1 = able to tolerate soft food, grade 2 = able to tolerate thick liquids, grade 3 = able to tolerate water
or clear fluids, and grade 4 = unable to tolerate anything perorally. Stent patency and patients survival rates were calculated.
Results: The insertion of the gastroduodenal stent was technically successful in 28 patients (96.5%). After stenting, 25 patients
(86.2%) showed clinical improvement by at least one score point. During follow-up, 22 (78.5%) of 28 patients showed no stent
occlusion until death and did not have to undergo any further intervention. In six patients (20.6%), all of whom were treated
with secondary stent insertions, occlusion with tumor ingrowth and/or overgrowth was observed after the intervention. The
median period of primary stent patency in our study was 240 days. Conclusion: Placement of an uncovered Wallstent is clinically effective in patients with malignant gastroduodenal obstruction. Stent
placement is associated with high technical success, good palliation effect, and high durability of stent function. 相似文献
9.
B. Acunas I. Rozanes I. Sayi S. Akpinar T. Terzioglu A. Kumbasar E. Gökmen 《European radiology》1995,5(6):599-602
Self-expanding nitinol stents were used in 22 patients for palliative treatment of malignant esophagogastric strictures. All patients but 5 were men (age range 47–75 years). The strictures were caused by squamous cell carcinoma (n = 12), adenocarcinoma (n = 8), and recurrent anastomotic carcinoma (n = 2). No technical failure or procedural complications occurred. After the procedure, the severity of dysphagia decreased at least one grade in all patients. Tumor ingrowth into the stent was seen in 7 patients of 22 (32%). Four of these patients were treated with additional stents, and in 3 patients, due to refusal, only balloon dilations were performed, which caused temporary relief. Tumor ingrowth into the stent was noted from 10 days to 7 months (mean 3 months). This seems to be a disadvantage of nitinol stents. At the end of the study 10 patients had died dead with a mean survival of 3 months (range 1 week to 6 months) and 12 patients were still alive with a mean follow-up of 4 months (range 1–8 months). It is concluded that nitinol stents provide satisfactory palliation in patients with malignant dysphagia with neglectable procedural morbidity and mortality rates. 相似文献
10.
11.
Iraha Y Murayama S Toita T Utsunomiya T Nagata O Akamine T Ogawa K Adachi G Tanigawa N 《Radiation Medicine》2006,24(4):247-252
Purpose The aim of this study was to evaluate the efficacy and complications of self-expandable metallic stent placement for patients
with inoperable esophageal carcinoma after radiotherapy and/or chemotherapy.
Materials and methods We obtained data from 19 patients with advanced or recurrent esophageal carcinoma between 1996 and 2000. In all patients,
a self-expandable metallic stent was placed under fluoroscopic guidance. Dysphagia before and after stent placement was graded.
Complications after stent placement were also evaluated. Data were compared between patients with and without prior radiotherapy
and/or chemotherapy.
Results The procedure was technically successful in all but one patient. The dysphagia grade improved in all patients. No life-threatening
complications occurred. The other major complications such as mediastinitis occurred in two patients, and pneumonia and funnel
phenomenon occurred in one patient each. These patients had a history of radiotherapy and/or chemotherapy prior to stent placement.
Eight of the twelve patients with prior radiotherapy and/or chemotherapy compared with one of seven patients without prior
therapy had persistent chest pain, which was a statistically significant difference (P < 0.05).
Conclusion Placement of self-expandable metallic stents was effective for patients with advanced or recurrent esophageal carcinoma. However,
prior irradiation and/or chemotherapy increased the risk of persistent chest pain after stent placement. 相似文献
12.
Neyaz Z Srivastava DN Thulkar S Bandhu S Gamanagatti S Julka PK Chattopadhyaya TK 《Acta radiologica (Stockholm, Sweden : 1987)》2007,48(2):156-164
Purpose: To study the role of self-expandable metallic stents in malignant esophageal strictures in terms of patency, improved dysphagia score, and possible associated complications.
Material and Methods: Twenty-two patients with inoperable carcinoma of the esophagus underwent stent placement. Four different varieties of covered stents were used. Stenting was performed under fluoroscopic guidance and local pharyngeal anesthesia. During follow-up, patients were examined clinically and radiologically to assess the effectiveness of stents in relieving dysphagia, to check the stent position, patency, and possible complications.
Results: Fluoroscopic placement of the stent was successful and well tolerated in all patients without any serious complications. Accurate stent placement was possible in 95% of cases. The mean dysphagia score prior to stenting was 3.5 and poststent 1.2, with an improvement of 2.3 degrees. In two patients with associated fistulas, complete closure was seen after stent insertion. There was poor stent expansion in three patients. Significant tumor overgrowth occurred in two patients, and a second overlapping stent was deployed in one case. Three patients developed food impaction, which needed endoscopic removal of impacted food in two cases.
Conclusion: Fluoroscopic placement of self-expandable metallic stents is a safe and effective method of palliating severe dysphagia and fistulas in patients with inoperable esophageal carcinoma. However, complications such as tumor overgrowth and food impaction may require reintervention after stent placement. 相似文献
Material and Methods: Twenty-two patients with inoperable carcinoma of the esophagus underwent stent placement. Four different varieties of covered stents were used. Stenting was performed under fluoroscopic guidance and local pharyngeal anesthesia. During follow-up, patients were examined clinically and radiologically to assess the effectiveness of stents in relieving dysphagia, to check the stent position, patency, and possible complications.
Results: Fluoroscopic placement of the stent was successful and well tolerated in all patients without any serious complications. Accurate stent placement was possible in 95% of cases. The mean dysphagia score prior to stenting was 3.5 and poststent 1.2, with an improvement of 2.3 degrees. In two patients with associated fistulas, complete closure was seen after stent insertion. There was poor stent expansion in three patients. Significant tumor overgrowth occurred in two patients, and a second overlapping stent was deployed in one case. Three patients developed food impaction, which needed endoscopic removal of impacted food in two cases.
Conclusion: Fluoroscopic placement of self-expandable metallic stents is a safe and effective method of palliating severe dysphagia and fistulas in patients with inoperable esophageal carcinoma. However, complications such as tumor overgrowth and food impaction may require reintervention after stent placement. 相似文献
13.
Poyanli A Sencer S Rozanes I Acunaş B 《Acta radiologica (Stockholm, Sweden : 1987)》2001,42(2):166-171
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. 相似文献
14.
To overcome the drawbacks of the modified Gianturco stent tube with barbs, a new barbless stent tube was constructed. Twenty-two barbless stent tubes 4.5-14.0 cm long were placed with a new introducing tube in 21 patients: 10 stent tubes in 10 patients with recurrent dysphagia after radiation therapy or chemotherapy, 10 in 10 patients with esophageal cancer in whom surgical management was contraindicated, and two in one patient with postoperative benign stricture. No technical failure or procedural complications occurred. After the procedure, all but two patients could ingest most or all foods. In two patients with an esophagorespiratory fistula and one patient with esophageal rupture, the barbless stent tube successfully occluded the fistula and rupture site. The stent tube migrated in one patient. Fifteen patients are surviving, with the stent tubes patent for 3-35 weeks (mean patency, 13 weeks); the six other patients died 7-24 weeks (mean, 16 weeks) after stent placement. It is concluded that barbless stent tubes show promise in the management of dysphagia caused by esophageal strictures. 相似文献
15.
Endovascular placement of self-expanding nitinol coil stents for the treatment of femoropopliteal obstructive disease 总被引:2,自引:0,他引:2
Jahnke T Voshage G Müller-Hülsbeck S Grimm J Heller M Brossmann J 《Journal of vascular and interventional radiology : JVIR》2002,13(3):257-266
PURPOSE: To report on a prospective two-center study to evaluate safety and effectiveness of a self-expanding nitinol coil stent in patients with femoropopliteal obstructive disease. MATERIALS AND METHODS: The IntraCoil nitinol stent was used in 37 patients (28 men and nine women; mean age, 62.4 y plus minus 10.7; range, 43-81 y) presenting with high-grade stenoses (n = 23) or short (<3 cm) occlusions (n = 17) of the superficial femoral artery (SFA; n = 33) or popliteal artery (n = 4). Indications for stent placement were significant residual stenosis (>30%) or dissection after angioplasty. Follow-up evaluations with measurement of the Doppler ankle-brachial index (ABI), assessment of Rutherford clinical stage, and color-coded duplex sonography were performed at discharge and 1, 3, 6, 12, and 18 months thereafter. Primary endpoints of the study were immediate technical and clinical success and 1-year patency. RESULTS: Initial technical success was achieved in all patients. In 10 patients (27%), more than one 40-mm-long device had to be implanted for total lesion coverage; in three patients (8.1%), stents were placed in two separate segments of the SFA simultaneously. The total number of stents deployed was 50. Stent placement induced an initial improvement of the ABI from 0.54 plus minus 0.2 to 0.92 plus minus 0.11 (P <.01). Follow-up data for 12 months after treatment are available for 29 of 37 patients (78.4%); mean follow-up is 15.6 months (range, 1-26 mo). Primary patency rates at 6 and 12 months were 97.1% (SE = 2.9) and 86.2% (SE = 6.5). The primary assisted patency rate was 100% at 12 months. CONCLUSION: Endovascular placement of the IntraCoil self-expanding nitinol coil stent for salvage of failed angioplasty in patients with femoropopliteal obstructive disease is an effective and safe procedure with promising mid-term results. 相似文献
16.
Choi GB Shin JH Song HY Lee YS Cho YK Bae JI Kim JH Jeong YH Park MH 《Journal of vascular and interventional radiology : JVIR》2005,16(12):1705-1710
PURPOSE: To evaluate the safety and clinical effectiveness of fluoroscopically guided balloon dilation in patients with esophageal stricture after radiation therapy (RT). MATERIALS AND METHODS: From April 1993 through December 2004, fluoroscopically guided balloon dilation was performed in 15 patients with esophageal strictures secondary to previous RT. Technical success, clinical success, recurrence of dysphagia, primary and secondary patency rates, and complications related to the procedure were retrospectively evaluated. RESULTS: Twenty-five balloon dilations were performed in 15 patients, with a mean of 1.7 dilations per patient (range, 1-5). Technical success was achieved in all procedures. One patient was immediately lost to follow-up and another underwent elective esophageal surgery 13 days after the procedure. Of the remaining 13 patients, clinical success was achieved 11 (85%). Two of 13 patients exhibited recurrence of dysphagia before 1 month after balloon dilation. Among the 11 patients in whom clinical success was achieved, seven exhibited maintained initial improvement of dysphagia until their last follow-up (mean, 174 days) and four exhibited recurrence of dysphagia after the first balloon dilation. Dysphagia recurred 2-128 days (mean, 67.2 d) after the first balloon dilation in six of the 13 patients (46%), who underwent further balloon dilation and/or stent placement. The primary and secondary patency rates at 1, 3, and 6 months were 86%, 68%, and 47% and 100%, 92%, and 62%, respectively. There were no major complications. Type 1 and 2 esophageal ruptures occurred after 12 dilations in nine patients; they were treated conservatively. CONCLUSION: Fluoroscopically guided balloon dilation for esophageal stricture after RT can be safe and effective. However, the high rate of recurrent dysphagia requires repeated dilations. 相似文献
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18.
金属内支架治疗食管恶性狭窄和球囊扩张治疗食管良性狭窄的随访研究 总被引:19,自引:0,他引:19
目的 研究食管恶性狭窄内支架治疗和食性狭窄球囊扩张的疗效。材料与方法 191例有较完整的随访资料,其中149例食管恶性狭窄置入内支架,93例置入支架前后作了放射治疗或化学药物治疗(占65%);42例良性食管狭窄作了球囊扩张治疗。门诊行食管造影和/胃内镜检查随访115例,通过电话或信伴随访34例。结果 随访观察1-56个,其中3野架发生轻度移位,但仍能改善病变全长,未作特殊处理。42例死亡,均为食管癌患者。术后生存时间2-34个月,平均9.5个月。恶性食管狭窄内支架置入再狭窄29例,因食物在支架内阻塞1例,因肿瘤生长发生狭窄24例,因支架上端组织增生发生狭窄4例。发生再狭窄的29例均再次作了内支架置入或球囊扩张治疗。结论 内支架置入治疗恶性食管狭窄能有效解除吞咽困难;应用带膜支架和同时作放化疗,可防止因肿瘤生长发生再狭窄,并能有效封堵食管气管瘘;吻合口和贲门癌狭窄应用返流支架,可预防返流性食管炎的发生。球囊扩张治疗良性食管狭窄,只要扩张充分,临床效果良好。 相似文献
19.