鼻胃镜直视下食管支架置入术40例

目的:探讨鼻胃镜在食管支架置入中的临床价值.方法:对40例晚期食管癌、贲门癌患者行鼻胃镜直视下食管支架置入术.狭窄严重者应用Savary-gilliard锥形硅胶扩张器预扩张至7mm,经鼻胃镜观察狭窄部位后计算支架推送器插入深度,并在鼻胃镜直视下调节支架推送器以保证支架位置准确,全程无需X线监控.分析支架置放成功率、定位准确性、并发症情况以及吞咽困难改善的效果.结果:40例患者均一次性成功放置食管支架,支架置入成功率100%,定位准确,膨胀满意,术后吞咽困难显著改善(3.52分±0.41分vs1.05分±0.38分,P<0.05),有1例发生迟发穿孔,严重并发症发生率2.5%.结论:鼻胃镜直视下食管支架置入术成功率高,操作简单、安全、定位准确,患者依从性好.     

超细胃镜在食管金属支架置放中的作用

目的:观察超细胃镜在食管金属支架放置中的作用．方法:对13例晚期食管／贲门癌(其中1例伴食管-气管瘘)及1例贲门失弛缓并吞咽困难患者应用Fujinon EG-270N5超细电子胃镜进行金属支架放置．术中对狭窄预扩张至9 mm,计算并控制输送器插入深度以及胃镜直视下调节输送器内支架上端位置以保证放置位置准确,全程无X线监控．观察支架放置成功率、定位准确性,扩张效果以及并发症情况．结果:全部患者支架一次性放置成功,定位准确;自膨满意,最狭窄处内径由2．73±3．18 mm扩至13．65±1．66 mm,食管气管瘘被覆盖阻断．吞咽困难评级由3．15±0．68降至0．91±0．49．结论:单纯超细胃镜下食管金属支架放置术患者依从性好:方法简便、准确、安全、有效．     

超细胃镜在老年食管金属支架置入术中的应用

近10年来超细胃镜的问世,有效地减轻了患者的痛苦,减少了恶心引起的心肺并发症.我院于2007年5月起应用超细胃镜对老年晚期食管癌、贲门癌患者行金属支架植入术,获得了满意疗效.1 资料与方法1.1 一般资料 42例均为不能或不愿手术的晚期食管癌、贲门癌患者,男27例,女15例,年龄60～82(平均69±8.5)岁.所有患者均有明显吞咽困难,其中合并冠心病24例、慢性阻塞性肺疾病10例、高血压16例、贫血10例.X线造影示食管狭窄长度3～10 cm,最狭窄处直径均＜6 mm,其中5～6 mm 19例,4～5 mm 10例,3～4 mm 4例,2～3 mm 5例,＜2 mm 4例.     

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。...     

经超细胃镜放置食管金属支架治疗食管恶性狭窄的疗效分析

食管癌向腔内生长易造成食管狭窄,导致患者吞咽困难,甚至出现进食后呕吐,严重影响患者的生活质量。内镜下食臀金属支架置入术可减轻食管狭窄,缓解吞咽梗阻症状,提高患者的生活质量,已成为治疗晚期食管癌的主要姑息治疗方法之一。     

超细胃镜直视下支架置入治疗上消化道良性狭窄9例

2007年12月至2008年11月间我院采用超细胃镜直视下置放全覆膜可回收记忆合金支架治疗上消化道良性狭窄患者9例，效果良好，现报道如下。     

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２８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。     

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。     

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...     

胃镜下支架放置术治疗食管瘘及食管狭窄的临床研究

以食管支架放置术治疗食管狭窄11例，其中食管癌7例(2例合并食管支气管痿)，术后吻合口狭窄1例，化学灼伤2例，食管外伤合并食管颈部狭窄1例，术前均有明显吞咽困难，所有患均一次置架成功，术后吞咽困难明显好转，食管痿愈合2例，胸痛和返流性食道炎是最常见的术后并发症，2例发生再狭窄(16．7％)，其中1例合并胸腔出口练合征。该法疗效确切，安全、经济。     

食管金属支架治疗125例食管狭窄和食管气管瘘临床分析

背景：食管狭窄和食管气管瘘是临床常见疾病，近年来食管金属支架逐渐成为其治疗的重要手段，并取得了良好的疗效。目的：探讨食管金属支架治疗食管狭窄和食管气管瘘的临床疗效。方法：选择125例良恶性食管狭窄和食管气管瘘患者，行内镜和x线检查以明确狭窄或瘘口的部位和性质。在x线引导下置入食管金属支架，术后密切随访观察临床疗效和并发症。结果：支架术后2周内，所有患者的吞咽困难均显著改善；食管气管瘘患者的呛咳均显著缓解，仪5例患者进流质时仍有轻微呛咳：86例(68．8％)患者术后出现胸痛，8例(6.4％)发生消化道出血，4例(3.2％)出现支架移位。术后半均随访时间为18个月。吞咽困难的平均缓解时间为7.4个月，27例恶性食管狭窄患者平均于术后6.4个月因肿瘤组织增生而导致再狭窄，8例良性食管狭窄患者平均于术后12．8个月因肉芽组织增生而导致再狭窄。38例患者有胃(或肠)食管反流表现，大多为吻合口支架或食管下段支架。7例患者出现支架移位。恶性食管狭窄患者支架术后平均存活时间为11．8个月。结论：食管金属支架能有效治疗良恶性食管狭窄和食管气管瘘，提高患者的生活质量。但支架术后再狭窄、食管功能紊乱和支架移位等并发症目前仍无法避免，且可能对支架的临床应用产生一定影响。     

Expandable Polyester Silicon-Covered Stent for Malignant Esophageal Structures before Neoadjuvant Chemoradiation: A Pilot Study

Patients with resectable esophageal cancer often require placement of a surgical jejunostomy tube prior to receiving chemoradiation so as to maintain adequate nutrition due to their inability to swallow and eat. This study reports a single institutional experience with the Polyflex self-expanding silicone stent (Rüsch; Kernen. Germany) in patients with malignant stenosis receiving chemoradiation prior to esophagectomy. This was a retrospective, nonrandomized study of 6 patients who underwent Polyflex esophageal stent placement across a malignant stricture prior to receiving neoadjuvant chemoradiation. The study assessed procedural success, restoration of oral nutrition, migration, and removal of the Polyflex stent. The outcomes measured were the efficacy of treatment, stent-related complications, and changes in the nutritional status of the patient after stent placement. Stent placement was successful in 5 of 6 patients (83%). Restoration of oral nutrition after stent placement occurred in 5 of 5 patients (100%). Migration of the stent into the stomach occurred in 3 patients (60%) without occurrence of gastric outlet obstruction; there was no proximal migration. Stents were successfully removed endoscopically or at the time of esophagectomy. This early experience suggests that the removable silicone Polyflex stent is an effective alternative to a surgical jejunostomy tube for the management of malignant esophageal stenosis in patients for whom neoadjuvant chemoradiation is planned prior to esophagectomy.     

冠状动脉内支架植入术150例护理体会

目的探讨冠状动脉内支架植入术患者的临床观察与护理对策。方法对150例行冠状动脉内支架植入术患者的术前、术中及术后观察与护理进行总结、归纳。结果本组均顺利完成手术,术后住院时间平均11d,无严重并发症发生。结论精心的术前、术中及术后护理能够减轻患者痛苦、提高患者舒适度、确保手术顺利进行、减少术后并发症。     

A Novel,Fully Covered Laser-Cut Nitinol Stent with Antimigration Properties for Nonresectable Distal Malignant Biliary Obstruction: A Multicenter Feasibility Study

Background/Aims

Stent migration occurs frequently, but the prevention of complications resulting from covered self-expandable metal stents (C-SEMSs) remains unresolved. We prospectively assessed a newly developed C-SEMS, a modified covered Zeo stent (m-CZS), in terms of its antimigration effect.

Methods

Between February 2010 and January 2011, an m-CZS was inserted into 42 patients (31 initial drainage cases and 11 reintervention cases) at a tertiary referral center and three affiliated hospitals. The laser-cut stent was flared for 1.5 cm at both ends, with a 1 cm raised bank located 1 cm in from each flared end. The main outcome of this study was the rate of stent migration, and secondary outcomes were the rate of recurrent biliary obstruction (RBO), the time to RBO, the frequencies of complications, and overall survival.

Results

Of the 31 patients with initial drainage, stent migration occurred in four (12.9%, 95% confidence interval, 5.1% to 29.0%), with a mean time of 131 days. RBO occurred in 18 (58%), with a median time to RBO of 107 days. Following previous C-SEMS migration, seven of 10 patients (70%) did not experience m-CZS migration until death.

Conclusions

m-CZSs with antimigration properties effectively, although not completely, prevented stent migration after stent insertion.     

上消化道出血合并食管管型1例

病例：患者女，38岁，于2007年11月8日以“一日内呕血3次，呕出灰白色管状物1条”为主诉急诊入院。入院前1d无明显诱因突感咽部烫痒不适，恶心明显，呕吐胃内容物2次，约100～200ml，含少许暗红色、黑色血块，第3次呕吐较剧烈，呕出鲜红色、咖啡色血液约200ml，以及1条约10cm长的白色管状物，一端连于口咽部，后自行吞咽回纳7cm，伴咽部、胸骨后刺痛不适、头晕、乏力、口干。     

内镜结合X线下支架置入术治疗胃出口恶性梗阻38例临床分析

背景：胃出口恶性梗阻的姑息治疗方法较多，但效果不理想，近年支架置入术成为治疗胃出口恶性梗阻的首选方法之一。目的：评价支架置入术治疗胃出口恶性梗阻的疗效以及内镜结合X线操作的优点。方法：取38例胃出口恶性梗阻患者，行内镜检查后经活检孔置入导丝，X线监视下置入并释放自膨式金属肠道支架。结果：38例患者成功置入42枚支架，其中TTS（through the seope）肠道支架3枚。支架置入后内镜和透视造影检查示支架均定位准确、通畅。所有患者均存在少量出血，16例（42．1％）予局部喷洒孟氏液止血，效果良好。37例（97．4％）患者术后3d可进食无渣或少渣食物，1例（2．6％）因远端小肠狭窄仍有呕吐，不能进食。术后随访发现16例（42．1％）患者术后3个月胃出121再次狭窄，其中4例（25．0％）再置入支架解决。38例患者的生存期为1～11个月不等，平均5．5个月。无大出血、穿孔、支架移位等并发症。结论：自膨式金属肠道支架置入术可有效治疗胃出口恶性梗阻，具有简单、创伤小、符合生理腔道和患者易耐受的优点，且对恶性梗阻的姑息治疗疗效优于传统外科手术治疗。内镜结合X线操作具有提高置入成功率、缩短操作时间、支架定位准确以及减少患者痛苦和手术相关并发症的优点。     

伊托必利对食管运动障碍NERD患者症状及食管动力的影响

目的 研究伊托必利对伴有食管运动障碍的非糜烂性反流病(NERD)患者症状及不同吞咽模式下食管运动功能的影响.方法 按标准选取具有典型胃食管反流症状及食管运动障碍的NERD患者34例,评估其胃食管反流症状,行不同物理性质食团(10次5 ml液体、10次胶体吞咽、10次2×2 ×2 cm固体吞咽)下高分辨率食管测压,给予伊...     

A Double-Layered Covered Biliary Metal Stent for the Management of Unresectable Malignant Biliary Obstruction: A Multicenter Feasibility Study

Background/AimsThe covered self-expandable metal stent (CMS) was developed to prevent tumor ingrowth-induced stent occlusion during the treatment of malignant biliary obstruction. However, complications such as cholecystitis, pancreatitis, and stent migration can occur after the endoscopic insertion of CMSs. The aim of the present study was to assess the efficacy and safety of a double-layered CMS (DCMS) for the management of malignant bile duct obstruction.MethodsDCMSs were endoscopically introduced into 59 patients with unresectable malignant extrahepatic biliary obstruction at four tertiary referral centers, and the patient medical records were retrospectively reviewed.ResultsBoth the technical and functional success rates were 100%. Procedure-related complications including pancreatitis, cholangitis, stent migration, and liver abscess occurred in five patients (8.5%). The median follow-up period was 265 days (range, 31 to 752 days). Cumulative stent patency rates were 68.2% and 40.8% at 6 and 12 months, respectively. At the final follow-up, the rate of stent occlusion was 33.9% (20/59), and the median stent patency period was 276 days (range, 2 to 706 days).ConclusionsThe clinical outcomes of DCMSs were comparable to the outcomes previously reported for CMSs with respect to stent patency period and complication rates.     

36例难治性胃食管反流病患者阻抗-pH监测结果分析

质子泵抑制剂（PPIs）广泛用于治疗胃食管反流病（GERD）,但部分患者对抑酸治疗的疗效不佳,称为难治性GERD。目的：研究难治性GERD患者食管内反流的严重程度和反流物性质,以探讨难治性GERD症状形成的因素。方法：选取2009年1月-2010年12月华东医院确诊的难治性GERD患者36例,以PPls治疗后症状得到缓解的12例GERD患者作为对照。行24h阻抗-pH监测,根据反流物pH值和阻抗值,分析比较两组的反流情况。结果：难治性GERD组24h总反流和弱酸反流次数的中位数（第25百分位数,第75百分位数）分别为98（58,136）和62（40,86）,均显著高于对照组（P〈0．001）;两组酸反流次数均控制在较低水平,且组问差异无统计学意义（P：0．423）。难治性GERD组的气体反流和液气混合反流次数分别为48（31,61）和41（22,58）,均显著高于对照组（P〈0．001,P=0．002）;液体反流次数无明显差异（P=0．757）。结论：弱酸反流在难治性GERD患者症状形成中起一定的作用,气体反流可能加重反流症状的感知。     

Transcatheter Closure of a Peripheral Arteriovenous Fistula: A Unique Use of a Covered Stent in a Child with Complex Congenital Heart Disease

Introduction. This report describes the use of a covered stent to occlude a surgical arteriovenous fistula in a child with complex cyanotic heart disease. Method. A single case report. Results. An Atrium iCAST covered stent was delivered percutaneously to the left axillary artery in an 8‐year‐old child with a failing single‐lung Fontan who had undergone the creation of a surgical axillary arteriovenous fistula to augment pulmonary blood flow. The covered stent completely occluded the fistula, without complications or compromise of arterial flow to the upper extremity. The patient subsequently experienced significant improvement in peripheral edema, ascites and pleural effusions. Conclusion. Although a single case report, this experience suggests a potentially important role for covered stents in the management of children with complex congenital heart disease.