晚期食管癌带膜记忆合金支架植入术的并发症防治

目的　探讨晚期食管癌带膜记忆合金支架植入的并发症及其防治措施。方法　应用带膜记忆合金支架治疗晚期食管癌117例,其中76例术前检查发现失去手术机会,6 例食管癌放疗、化疗或术后吻合口复发,2例食管癌合并食管气管瘘,采用介入法放置支架;33例尚有手术探查指征,术中见肿瘤无法手术切除而于术中放置支架。观察近、远期并发症,并给予相应处理。结果　117 例患者植入支架131支,其中14例放置 2 枚支架。全组无手术死亡病例。近期并发症发生率为 40.2%(47/117),其中33例胸部膨胀感、钝痛,2 例室性心律失常,5 例支架移位,7 例出血。远期并发症发生率为18.6%(11/59),其中 2 例支架内食物堵塞,4 例出血,5 例肿瘤生长超过支架上端而再狭窄。除1例术后12天大呕血死亡外,其余均采取相应措施处理成功。结论　降低晚期食管癌带膜记忆合金支架植入并发症必须采取术前、术中和术后的综合防治措施。

Complications of membrane-covered self-expanding stent insertion for advanced esophageal carcinoma

Objective To explore the prevention and treatment methods of the complications of covered self-expanding metallic stent insertion for advanced esophageal carcinoma. Methods 131 membrane-covered self-expanding stents were inserted in 117 patients with advanced esophageal carcinoma. 84 patients underwent insertion of stents under radiological guidance, and the rest who received thoracotomy with unresectable esophageal carcinoma underwent insertion of stents by surgery. The short- and long-term complications of stent insertion were observed and treated. Results Every insertion was successful and there was no operative death. The short-term complication rate was 40.2% (47/117) including 33 chest pain or discomfort, 2 ventricular arrhythmia, 5 stent migration, and 7 bleed. And the long-term one was 18.6% (11/59) which included 2 obstructive stents with food, 4 bleed, and 5 recurrence of esophageal stricture for tumor overran the stent. All complications were successfully treated except one case died 12 days postoperatively for hematemesis. Conclusions To reduce the complication rate of covered self-expanding stents insertion for advanced esophageal carcinoma, a series of prevention and treatment methods should necessary.