内镜下覆膜可回收食管支架与扩张器治疗食管吻合口良性狭窄的疗效与安全性比较

摘要 背景：随着食管支架工艺技术的不断进步，可回收食管支架治疗食管术后吻合口良性狭窄的疗法快速发展。 目的：比较传统扩张器扩张疗法与放置覆膜可回收食管支架疗法治疗食管术后吻合口良性狭窄的疗效、生物相容性和安全性。 方法：纳入54例食管术后吻合口狭窄患者按照自愿原则分为扩张器组和支架组，支架组置入MTN-SE-G-18/60和MTN-SE-G-20/60两种不同型号的镍钛记忆合金支架，便于不同吻合口直径患者的选择；扩张组置入硅胶扩张器。随访观察治疗后1，3，6个月吻合口大小、吞咽困难变化及并发症发生等情况。 结果与结论：扩张组因需要反复扩张，咽喉部疼痛及局部渗血的发生率明显高于支架组，且有1例发生食管穿孔。两组患者治疗后1，3，6个月时吻合口的直径均逐渐减小，但较治疗前明显增大。支架组患者治疗后吻合口扩张及吞咽困难改善情况均优于扩张组，6个月时吻合口直径分别为0.94 cm和0.63 cm(P < 0.01)，能正常进食的比例分别为88%和48%(P=0.005)。提示，相对于扩张器治疗食管术后吻合口狭窄，镜下置入镍钛记忆合金全覆膜可回收食管支架的方法操作简便，并发症少且短暂，安全性高，患者痛苦小，易接受，远期疗效优。 关键词：食管支架；扩张器；吻合口；狭窄；胃镜检查；导丝 doi:10.3969/j.issn.1673-8225.2011.16.041

Efficacy and safety comparison of traditional dilator therapy and retrievable esophageal covered stent therapy in the treatment of benign esophageal stenosis under endoscope

Abstract BACKGROUND: With continuous progress in esophageal stent technology, retrievable esophageal covered stents are widely used in the treatment of benign esophageal stenosis. OBJECTIVE: To compare the efficacy, biocompatibility and safety of traditional dilator therapy versus retrievable esophageal covered stent therapy in the treatment of benign esophageal stenosis. METHODS: Fifty-four cases with esophageal anastomotic stenosis were voluntarily divided into dilator group and stent group. Stent group was implanted with two different types of nickel-titanium shape memory alloy stents of MTN-SE-G-18/60 and MTN-SE-G-20/60, for patients with different anastomosis diameter. Dilator group was given silicone expandor. Anastomotic size, degree of dysphagia and complications were measured during 1, 3, 6 months follow-up after treatment. RESULTS AND CONCLUSION: Due to repeated dilation, the throat pain and the incidence of local bleeding were significantly higher in dilator group than those in stent group, and 1 case exhibited esophageal perforation. For the two groups of patients at 1, 3, 6 months after treatment, the diameter of the anastomotic stoma were gradually decreased, but significantly increased compared with before treatment. The anastomotic expansion and dysphagia improvements were better in stent group than that in dilator group, especially at 6 months, the anastomotic diameters were average 0.94 cm and 0.63 cm, respectively (P < 0.01), and the ratio of eating normally was 88% and 48% respectively (P = 0.005). In comparison with the dilator therapy, the treatment of esophageal anastomotic stricture with retrievable covered stents under endoscope is simple, less complications, safe, little pain, easy to accept and with excellent long-term effect.