带膜支架治疗高位食管疾病

目的:探讨食管带膜支架治疗高位食管癌、食管-气管瘘、吻合口狭窄的效果及支架置人的一些相关问题.方法:采用内镜法、直接法为高位晚期食管癌、食管-气管瘘、高位吻合口狭窄等患者23例共置入23个支架.结果:疗效满意,明显改善了患者生活质量;1例支架置入后疼痛严重取出支架;3例支架置入位置有误经内镜成功调整;6例发生咽功能紊乱经治疗后5例痊愈,1例取出支架.结论:食管带膜支架置人术只要定位准确,不失是一种操作简单有效,安全可靠的方法,特别适于晚期食管癌的狭窄和食管-气管瘘.吻合口狭窄的治疗不首选支架.支架置入后疼痛、咽功能紊乱及支架置入位置有误也可经积极处理解决.

Treatment of high-positioned esophageal diseases with membrane-covered self-expanding stents

Objective:To evaluate therapeutic effect of membrane-covered self-expanding metallic stent on high-positioned advanced esophageal carcinoma,esophagotracheal fistula and anastomotic stricture,and relevant problems to stent implantation.Methods:23 membrane-covered self-expandable stents were implanted in 23 patients with high-positioned advanced esophageal carcinoma (12 cases),esophagotracheal fistula (6 cases) and high-positioned anastomotic stricture (5 cases).The implantation of the stents was performed under endoscope or perorally.Results:The severity of dysphagia was reduced,and life quality of the patients was improved significantly.One stent had to be taken out for severe pain. The positions of 3 stents were successfully adjusted by endoscope for improper position after the first implantation.6 patients suffered from the disorder of pharyngeal function after implantation,among which 5 were cured,and 1 had the stent taken out.Conclusion:Membrane-covered self-expanding metallic stent is effective,safe and easy to insert,especially for patients with the stricture of the high-positioned advanced esophageal carcinoma,and the esophagotracheal fistula.However stent is not the first choice for the treatment of anastomotic stricture.Post-implantation pain,improper position of stent and the disorder of pharyngeal function can be solved by active management.