内镜超声小探头辅助支架置入治疗食管恶性狭窄

目的探讨对内镜无法通过且吞服造影剂未能明确狭窄长度的食管恶性狭窄利用内镜超声小探头(miniprobe endoscopic ultrasound，mEUS)辅助镜下直视支架置入的有效性和安全性。 方法回顾性分析2008年7月至2017年8月成都市第三人民医院收治的158例符合上述特征的食管恶性狭窄患者的诊治资料，其中92例采用普通胃镜下将导丝通过狭窄处、扩张至镜身可通过并测量狭窄长度后放置支架(对照组)，66例利用mEUS通过狭窄处并测量狭窄段长度，然后放置导丝和置入支架(mEUS组)。比较2种方法的技术成功率，操作时间，术中出血，术后胸痛、支架移位、再狭窄的发生率。 结果mEUS组比对照组技术成功率高(100%比87.0%)、操作时间短(11.80±2.21)min比(14.65±3.63)min]、术中出血发生率低(7.6%比20.7%)，差异有统计学意义(P<0.05)。mEUS组和对照组在术后胸痛发生率(65.2%比59.8%)、支架移位率(4.5%比8.7%)和再狭窄率(22.7%比16.3%)比较，2组差异无统计学意义(P>0.05)。 结论mEUS辅助支架置入对常规胃镜无法通过且吞服造影剂未能明确狭窄长度的食管恶性狭窄更加简便安全有效。

Miniprobe endoscopic ultrasound assisted stenting for malignant esophageal stricture

ObjectiveTo investigate the efficacy and safety of miniprobe endoscopic ultrasound(mEUS)-assisted stenting for malignant esophageal strictures of undetermined length and failed passage of gastroscope. MethodsThe data of 158 patients receiving endoscopic stenting for malignant esophageal strictures with the aforementioned features from July 2008 to August 2017 in the Third People′s Hospital of Chengdu were retrospectively analyzed.Conventional approach, which includes passage of guidewire through stricture, dilation for passage of gastroscope to measure length of the stricture, and stent deploy, was adopted on control group(n=92). While endosonography-guided miniprobe passage and measurement of stricture for subsequent stenting were performed on the mEUS group(n=92). Technical success rate, procedural time, intraoperative hemorrhage, postoperative retrosternal pain, stent dislodgement and stricture recurrence were compared between the two groups. ResultsTechnical success rate was increased in mEUS group compared with that of control group(100% vs.87.0%), while procedural time (11.80±2.21)min vs.(14.65±3.63)min]and intraoperative hemorrhage rate(7.6% vs.20.7%)were decreased, and the differences were statistically significant(P<0.05). The incidence rates of postoperative retrosternal pain(65.2% vs.59.8%), stent dislodgement(4.5% vs.8.7%)and stricture recurrence(22.7% vs.16.3%)were insignificantly different between the two groups(P>0.05). ConclusionmEUS-assisted stenting for malignant esophageal strictures of undetermined length and failed passage of gastroscope has improved safety and efficacy.