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。     

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…     

带膜网状镍钛合金支架治疗恶性病变引起的食管狭窄

目的 通过使用带膜网状镍钛合金支架治疗恶性病变引起的食管狭窄,评价该支架的临床应用价值.方法 对38例食管狭窄患者行食管支架植入,其中晚期食管癌引起食管狭窄23例(1例上段食管癌合并食管-气管瘘),晚期贲门癌4例,食管、贲门癌术后吻合口复发6例,肺癌侵及食管4例,纵隔淋巴结转移癌压迫食管1例.全部病例均在X线电视监视下经口食管扩张后放入带膜网状镍钛合金支架,术后全身静脉化疗并进行随访.结果 本组无手术死亡.38例共进行39次支架植入,均一次性放置成功,其中1例因肿瘤生长超过原支架上缘引起再堵塞,而于首次支架植入2.5个月后第2次放置,1例15cm长食管癌患者同时放置2根支架.支架植入后静脉化疗(卡铂+5氟脲嘧啶,共4个疗程).随访观察35例,26例平均生存4.5个月后死亡;6例生存11～19个月,平均1 6个月;3例生存超过24个月.死前1～7 d均可进食,无严重并发症发生.结论 带膜网状镍钛合金支架治疗恶性病变引起的食管狭窄,可较好地改善患者的进食状况,提高生活质量.     

食管金属要治疗食管良,恶性狭窄

目的 通过对１２４例食管良、恶性狭窄患者的治疗,探讨食管金属支架治疗的临床效果、适应证、并发症以及治疗过程中存在的问题。方法 食管狭窄患者在内窥镜和食管Ｘ线透视下进行食管金属支架治疗。分别置入镍钛记忆合金支架８３例次,带膜不风支架４７例次。结果 金属支架操作均一次性完成,位置良好,支架扩张内径１．２￣１．６ｃｍ,吞咽困难程度由术前的３．３５％下降至１．０５％,患者恢复正常饮食。并发症为下胸痛、反流     

食管腔内支架置入术致医源性狭窄4例

例 1　女 ,5 6岁。食管中段憩室局部切除缝合术后吻合口胸膜腔瘘 2个月 ,食管腔内置入带膜记忆合金支架 ,进食通畅。置管后 8个月出现下咽困难 ,Ｘ线钡餐检查见支架上口狭窄 ,内径 0 5ｃｍ。经食管镜取架失败。全麻下经胸腹联合切口 ,探及支架上、下端喇叭口深深插入食管壁 ,呈环状狭窄 ,将支架顺利取出缝合切口。例 2　男 ,5 0岁。食管胃主动脉弓上吻合术后吻合口狭窄 ,行带膜钛记忆合金支架置入术 ,术后进食正常。支架置入 10个月后再次出现吞咽不畅 ,并渐加重 ,食管造影显示支架上端局部管腔不规则 ,钡剂通过受阻。再次行支架置入术后症…     

食管内支架置入术治疗食管狭窄

我院自 1995年 1月至 1999年 12月 ,应用食管内支架置入术治疗食管狭窄 2 1例 ,效果良好 ,现报道如下。1.一般临床资料与方法 :本组 ,男 17例 ,女 4例 ;年龄 44～ 80岁 ,平均 (6 1±9 0 )岁 ;食管中段癌 11例 ,食管下段癌 6例 ,贲门癌 2例 ,食管、贲门癌术后狭窄 2例 ,其中癌性食管气管瘘 4例 ;患者出现吞咽困难 3～ 7个月 ,其中 1例已不能进食 ,16例仅能进流质饮食 ,4例能进半流质饮食。所有病例均经Ｘ线钡餐造影证实食管狭窄段长度 [1～ 11ｃｍ ,平均(5 0± 3 0 )ｃｍ]和内径 ;经内镜和病理确诊病变性质。梗阻程度按ｘｔｏｏｌｅｒ分级 :…     

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。     

记忆合金胆道支架在不能切除的肝门区胆管癌术中的应用(附17例报告)

目的探讨记忆合金胆道支架置入在不能切除的肝门区胆管癌手术中的可行性和临床应用价值。方法1998年1月～2006年1月，我院对17例术中发现无法根治切除的晚期肝门部胆管癌，经胆总管切开置入记忆合金支架扩张闭塞或狭窄的胆管，完成胆汁内引流。结果17例放置支架术后2周内黄疸消退，经引流管造影显示胆道梗阻解除。16例随访4—30个月，平均11．5月，13例死亡（生存期4～20个月，平均11个月），3例分别已经存活10、12．5、30个月。结论对术中发现无法根治切除的肝门区胆管癌患者，记忆合金胆道支架置入术操作简单，能有效解除梗阻性黄疸，是一种较好的姑息治疗方法。     

肝移植术后肝动脉狭窄的内支架治疗

目的 对内支架植入术治疗肝移植术后肝动脉狭窄的价值进行初步的探讨。方法 对34例肝移植发生肝动脉狭窄、闭塞患者行球囊扩张治疗，其中5例患者接受内支架植入治疗，3例为球囊扩张治疗无效患者，1例为球囊扩张后出现肝动脉内膜撕裂，另1例为肝动脉狭窄伴吻合口破裂出血。结果 5例患者均成功进行了内支架植入治疗，其中1例肝动脉狭窄伴吻合口破裂出血的患者植入支架后24h内发生支架内急性血栓形成，经手术行肝动脉重建治疗，其余4例术后治疗效果良好。结论 介入方法治疗肝移植术后肝动脉狭窄具有微创、安全、有效的优势，对于球囊扩张治疗无效或合并吻合口破裂出血的病例，可采用内支架植入治疗。     

原位肝移植术后下腔静脉狭窄的诊治

目的：总结原位肝移植术后下腔静脉狭窄的诊治经验,方法：总结51例原位肝移植术后3例下腔静脉狭窄的临床资料。结果：本组下腔静脉狭窄发生率为5．8％（3／51）,3例均为肝后段下腔静脉狭窄,均发生在术后1个月内,均经超声检查及下腔静脉造影证实,经皮腔内腔静脉气囊扩张或放置内支架后,血流恢复通畅,下肢水肿消失,例1术后第14d死于脑出血,例2和例3恢复顺利,肝功能良好,现已分别存活18个月,4个月,经彩超检查证实下腔静脉血流通畅。结论：经皮腔血管成形术及放置血管内支架治疗肝移植术后早期下腔静狭窄安全可靠,近期疗效满意。     

Prospective evaluation of a new self-expanding plastic stent for inoperable esophageal strictures

BACKGROUND: High stent cost is considered the major drawback of self-expanding metal stents for dysphagia palliation in patients with inoperable esophageal strictures. We report our experience with a self-expanding plastic (Polyflex) stent, the cost of which is half that of the metal stents. METHODS: Between September 1999 and April 2001, 16 dysphagic patients (15 men; mean age, 69.4 +/- 14.5 years; range, 49-100 years; mean dysphagia score, 3.31 +/- 0.6) with esophageal strictures who underwent Polyflex stent placement (insertion device diameter, 12-14 mm; postexpansion inner stent diameter, 16-21 mm; stent length, 9, 12, and 15 cm) were studied prospectively. The strictures were caused by postsurgical recurrence of gastric/esophageal cancer at the anastomotic site in five patients, primary esophageal cancer in four patients, esophagocardia junction cancer in four patients, metastatic mediastinal lymph nodes from a primary lung cancer invading the esophagus in 1 patient, and benign peptic stricture in two elderly patients. All the patients were prospectively followed until death. RESULTS: Stent insertion was technically successful in 12 patients (75%). Stent placement failed in four patients (25%) because of failure to pass the delivery catheter across the stricture in three patients and failure of the stent to open in one patient. Early and late stent migration occurred in two patients and 1 patient, respectively. Tumor overgrowth occurred in 1 patient. The mean dysphagia score 7 days after stent placement was 1.1 +/- 0.9. Mean survival was 100.6 +/- 71.2 days (range, 8-225 days). CONCLUSION: Self-expanding Polyflex stents are safe and effective for inoperable esophageal strictures and have an acceptable technical success rate. Further experience, better selection criteria, and design improvements should improve results.     

内镜联合X线监视下支架植入治疗中晚期食管癌恶性梗阻的临床应用

目的探讨内镜联合X线监视下支架植入治疗中晚期食管癌恶性梗阻的临床疗效。 方法选择2010年6月—2017年10月在内蒙古呼和浩特市第一医院中晚期食管癌恶性梗阻的67例患者,根据患者意愿分为内镜联合X线监视下支架植入组(联合组,n＝35)和X线监视下放置支架组(普通组,n＝32)。观察比较两组患者术前及术后1～3个月的生活质量和吞咽困难指数变化情况,观察患者的术后并发症并及时对症治疗;统计术后患者的生存期与存活率,并采用生存质量核心问卷(QLQ-C30)和食管癌专用量表(OES-18)调查患者的生活质量。 结果两组患者均一次性成功植入支架,成功率达100%,吞咽困难立刻改善明显,两组评分由联合组和普通组的(3.3 ±0.6)和(3.2 ±0.7)分改善为(1.0±03)分,1周后的评分均改善为0分。两组患者术中、术后无大出血和穿孔的发生,均有不同程度的胸骨后疼痛和不适,大多数均不需特殊处理。联合组患者的再阻塞率、生存时间、生存质量明显高于普通组患者(P<0.05),联合组的再阻塞率明显低于普通组患者(P<0.05);但两组间支架移位率无统计学差异(P>0.05)。 结论应用内镜和X线双重定位下植入支架治疗不愿或不能手术切除的中晚期食管癌患者,具有创伤小、安全、定位准确等特点,能迅速缓解患者的症状,提高生存质量,延长生存时间,具有良好的临床应用价值。     

Partially covered esophageal stents cause bowel injury when used to treat complications of bariatric surgery

Background

We hypothesized that an esophageal nitinol stent that is mainly silicone-covered but partially uncovered may allow tissue ingrowth and decrease the migration rate seen with fully covered stents and still allow safe stent removal. The aim of this study was to evaluate the first human results of using partially covered stents for anastomotic complications of bariatric surgery.

Methods

This was a retrospective evaluation of all patients with staple-line complications after bariatric surgery who received a partly covered stent at a single tertiary-care bariatric center. The stents varied in length from 10 to 15 cm and in diameter from 18 to 23 mm.

Results

From April 2009 to April 2010, eight patients received partially covered stents on 14 separate occasions. The indications were gastrojejunal stricture in four, acute leak in two, acute leak followed by a later stricture in one, and a perforated anastomotic ulcer in one patient. Single stents were placed in 12 sessions and two overlapping stents in two sessions. At the time of stent deployment, one patient had the uncovered proximal end of the stent in the stomach, with all others in the distal esophagus. Immediate symptom improvement occurred in 12/14 stent placements. Oral nutrition was initiated for 10/14 stent treatments within 48 h. Stents were removed after 25 ± 10 days. Minor stent displacement occurred with 9/13 stents, with the proximal end of the stent moving into the stomach, though the site of pathology remained covered. The stents were difficult to remove when tissue ingrowth was present. One patient required laparoscopic removal and one required two endoscopy sessions for removal. At the time of removal of ten stents, where the proximal end was found in the stomach, four had gastric ulceration, three had gastric mucosa replaced by granulation tissue, and three had normal gastric mucosa. In four cases where the proximal portion of the stent stayed in the esophagus, the esophageal deployment zone had abnormalities: three with granulation tissue and one with denuding of the esophageal mucosa. The distal uncovered portion of the stent in the Roux limb never became embedded in the mucosa and caused minimal injury.

Conclusions

A partially covered stent was successful in keeping the site of the pathology covered and provided rapid symptom improvement and oral nutrition in most patients. The proximal end of the stent generally moved from the esophagus to the stomach, probably due to esophageal peristalsis. The proximal uncovered portion of the stent causes significant bowel mucosal injury and sometimes becomes embedded in the esophagus or the stomach, making removal difficult. We no longer use partially covered stents.     

Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy

Background In patients with esophagectomy and gastric pull up for esophageal carcinoma anastomotic leaks are a well-known complication and a major cause of morbidity and mortality. Objective We evaluated stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy. Methods 269 patients with esophageal cancer (adenocarcinoma n = 212, squamous cell carcinoma n = 57) had undergone esophagectomy and gastric pull up with an intrathoracic anastomosis between January 1998 and December 2005. A thoracic anastomotic leak was clinically and endoscopically proven in 12 patients (4.5%). Endoscopic insertion of a self-expanding covered metal stent at the site of the anastomotic leak was performed in 10 patients; two patients were treated with fibrin glue. Results Stents were successfully placed in all patients without complications. In all but one patient (n = 9) radiological examination showed complete closure of the leakage. In one patient the stent was endoscopically corrected and complete closure could be achieved thereafter. The stent could be removed after six weeks in five patients. Stent migration occurred in four patients. In all but one patient (n = 7) definitive leak occlusion was achieved. Two patients died during their hospital stayfor reasons not related to the stent placement. Conclusion Stent implantation in patients with thoracic anastomotic leaks after esophagectomy is an easily available and effective treatment option with low morbidity, but stent migration does occur.     

Use of temporary esophageal stent in management of perforations after benign esophageal surgery

Successful conservative management in 3 patients with catastrophic postoperative esophageal leak after nonresection surgery is presented. In each case, the placement of removable stent played a significant role. First patient had persistent leak after primary repair of intrathoracic esophageal perforation. The second patient underwent a transthoracic redo Collis-Nissen repair and was subsequently found to have a perforation in the midesophagus. The last patient had a history of recurrent hiatal hernia repair with mesh reinforcement of the hiatus. A perforation resulted from mesh eroding into the esophagus. All the patients had endoscopic placement of removable silicone-covered polyester stent under fluoroscopic guidance. Stent placement was successful in all patients allowing immediate resumption of diet. After stent removal, contrast study showed no leak or stricture. Endoscopic stent therapy is an effective option in the management of postoperative esophageal perforation.     

Double stenting for esophageal and tracheobronchial stenoses

Background. We examined the complications and outcomes of placing stents for both esophageal and tracheobronchial stenoses.

Methods. We placed stents for both esophageal and tracheobronchial stenoses in 8 patients (7 with esophageal cancer and 1 with lung cancer). Covered or noncovered metallic stents were used for the esophageal stenoses, except in 1 patient treated with a silicone stent. Silicone stents were used for the tracheobronchial stenoses. The grades of esophageal and tracheobronchial stenoses were scored.

Results. All patients experienced improvement of grades of both dysphagia and respiratory symptoms after stent therapy. The complications were: (1) 2 patients suffered respiratory distress after placement of the esophageal stent because of compression of the trachea by the stent; and (2) 3 patients developed new esophagotracheobronchial fistulae, and 2 patients had recurring fistula symptoms because of growth of preexisting fistulae after the stent placement, which were caused by pressure from the 2 stents. Despite the fistulae, the 5 patients treated with covered metallic stents did not complain of fistula symptoms, but 2 patients treated with noncovered metallic or silicone stents did complain.

Conclusions. For patients with both esophageal and tracheobronchial stenoses, a stent should be introduced into the tracheobronchus first. Because placement of stents in both the esophagus and tracheobronchus has a high risk of enlargement of the fistula, a covered metallic stent is preferable for esophageal cancer involving the tracheobronchus.     

The palliation of dysphagia secondary to esophageal-cardial carcinoma with self-expandable metal prostheses. The authors' personal experience with 92 patients]

BACKGROUND: Endoscopic insertion of a stent is an important option in the palliative management of esophageal obstruction and esophagorespiratory fistula. Plastic stents have been available for over 20 years. A new class of self-expanding metal stents for palliation of esophageal and cardial cancer is now available. METHODS: Between September 1992 and October 1997, 92 patients underwent implantation of self-expanding metal stents for palliation of dysphagia due to inoperable esophageal or cardial cancer (65 patients) or for locally recurrent carcinoma after surgery (12 patients), laser-therapy (11 patients) or radiotherapy (4 patients). RESULTS: Successful stent implantation was achieved in 89/92 patients (96.7%). After stent implantation the dysphagia score improved from 3.0, on average, to 0.5, on average. Early complications were observed in 4.5% and peroperative mortality was 2.1%. Late complications were observed in 25.6%, with a mortality rate of 1.1%. The mean survival time was 6.9 months. CONCLUSIONS: Self-expanding metal stents are a new effective alternative for palliation of dysphagia due to esophageal and cardial cancers.     

Early migration of fully covered double-layered metallic stents for post-gastric bypass anastomotic strictures

INTRODUCTIONLaparoscopic Roux-en-Y gastric bypass (LRYGB) is well recognized for its efficiency in morbidly obese patients. Anastomotic strictures present in 5–15% of cases and have a significant impact on the patient's quality of life. Endoscopic balloon dilation is the recommended treatment but management of refractory cases is challenging.PRESENTATION OF CASETwo patients with anastomotic stenoses refractory to dilations were treated with fully covered esophageal stents. Both cases presented early stent migration. The first patient finally underwent surgical revision of the anastomosis. For the second patient, a double-layered stent was installed after the first incident. After the migration of this second stent, three sessions of intralesional injection of triamcinolone acetonide were performed. Both patients were free of obstructive symptoms at a follow-up of 9 months.DISCUSSIONTreatment of post-gastric bypass strictures with stents is based on years of successful experience with endoscopic stenting of malignant esophageal strictures, gastric outlet obstruction in addition to anastomotic stenoses after esophageal cancer surgery. The actual prosthesis are however inadequate for the particularities of the LRYGB anastomosis with a high migration rate. Intralesional corticosteroid injection therapy has been reported to be beneficial in the management of refractory benign esophageal strictures and seems to have prevented recurrence of the stenosis in this post-LRYGB.CONCLUSIONStents are aimed at preventing a complex surgical reintervention but are not yet specifically designed for that indication. Local infiltration of corticosteroids at the time of dilation may prevent recurrence of the anastomotic stricture.     

生物可降解食管支架的研究进展

食管狭窄直接影响患者生存质量,严重威胁患者生命安全。食管支架,尤其是生物可降解食管支架的应用为食管狭窄患者带来了福音。生物可降解食管支架包括SX Ella-BD支架、聚乳酸支架及聚乳酸己内酯共聚物支架。本文对生物可降解食管支架的重要性和必要性及其研究进展进行综述。     

A New Method of Thermo-chemotherapy Using a Stent for Patients with Esophageal Cancer

Purpose Many patients with advanced esophageal cancer have a stent inserted in the esophagus, but very little else can be done. We devised a new method of delivering thermotherapy using an implant heating system (IHS) with a metallic stent. To our knowledge, there are no other reports of thermotherapy using metallic stents. We report our clinical results of treating patients with this new technique. Methods A metallic stent was placed in the esophagus and heated for thermotherapy. This was combined with simultaneous chemotherapy in 13 patients and radio-chemotherapy in 5 patients. Each thermotherapy session consisted of heating the stent to 50°C for 10 min. These 18 patients received a collective 52 sessions of thermotherapy. The tumor was excised after this treatment in 5 of these 18 patients. Results We evaluated 17 of the 18 patients, after the exclusion of 1 patient who underwent radio-chemotherapy before placement of the stent. There was 1 complete response (CR) and 12 partial responses (PR), accounting for 76%. The patient with a CR had no residual cancer cells detected by pathologic examination after surgical resection. Thermotherapy proved effective in 8 (89%) of 9 patients who received this treatment at least three times. It was effective in all (100%) patients who underwent concomitant radio-chemotherapy. Conclusions Our results show that thermotherapy using a stent can improve the effectiveness of combination therapy, suppress local tumor growth, and enhance quality of life over a long period.