金属食管支架治疗食管恶性狭窄22例分析

目的]研究金属支架治疗食管恶性狭窄的价值。方法]采用镍钛合金和Z型支架治疗食管狭窄22例 (18例恶性狭窄 ,4例吻合口狭窄 ) ,包括6例食管支气管瘘。通过胃镜在X线下确定狭窄段的上下缘 ,以及瘘管的位置 ,并在体外和体内定位 ,拔出胃镜后留置导丝 ,将支架置入器沿导丝送到狭窄部位 ,在X线透视下确定支架位置正确后 ,缓慢释放支架 ,并适当调整位置。结果]病人置放支架后吞咽困难分级降低1.67个等级 ,食管直径由(0.4±0.2)cm扩张至(1.6±0.2)cm。带膜金属支架使瘘口完全封闭 ,术后无严重并发症发生。结论]金属支架治疗对于不能手术切除的晚期食管癌 ,食管瘘或手术后吻合口狭窄以及吻合口复发的病人是有效的姑息治疗方法 ,带膜支架对食管支气管瘘堵瘘非常有效

Metallic Stent in the Treatment of Malignant Esophageal Stricture

To evaluate the clinical value of expandable metallic stent in the treatment of patients with malignant esophageal stricture.Twenty_two patients underwent implantation of self-expanding Ni,Ti or Z stents for esophageal stricture(18 patients with malignant stricture and 4 patients with benign esophageal stricture),6 patients had esophageal fistula. All patients underwent esophageal dilatation using a flexible gastroscope and bougies before implantation of the stent.Dysphagia was improved significantly. The degree of dysphagia was reduced from 3.14 grades to 1.47 grades. The esophagotracheal fistula was sealed off. No severe complication had occured.Conclusion]Ni,Ti and Z self-expandig metallic stent is effective for malignant stricture.Membrane-covered seft-expanding stent is effective for esophagorespiratary fistula.