多次、多枚支架置入在食管恶性狭窄治疗中的临床应用价值研究

目的:探讨多次、多枚支架置入术对治疗食管恶性狭窄的临床应用价值.方法:8例患者中有6例于第一枚支架置入后3～12个月时因肿瘤进展累及到支架上或下口引起再次梗阻,而置入第二枚支架,其中又有2例分别于置入第二枚支架后10个月(第1枚支架置入后19个月)因肿瘤再次进展和13个月(第1枚支架置入后25个月)因支架上口肉芽组织过度增生引起梗阻而置入第三枚支架.1例食管中、下段双段食道癌患者,一次同时重叠置入二枚支架.1例女性高龄患者置入第一枚支架三天后出现食管-气管瘘而再次套置第二枚支架.结果:6例因肿瘤进展多次置入支架患者及1例双段食道癌双支架置入患者支架置入后均开通食管梗阻,提高了患者生活质量,延长了患者生存时间.2例置入三枚支架患者生存均超过50个月.食管-气管瘘患者置入支架后立即封堵了瘘口,但患者于一周后出现消化道大出血死亡.结论:食管恶性狭窄支架置入后肿瘤进展造成再次狭窄及食管多发肿瘤,采取支架多次及多枚置入有着重要的临床价值.

Clinical Application of Repeated Multiple Stent-Insertion in the Treatment Of Malignant Esophageal Stricture

Objective:To investigate the clinical value of repeated multiple stent-insertion in the treatment of malignant esophageal stricture.Methods:Of 8 patients with malignant esophageal stricture,the second stent was inserted in six patients with obstruction of the upper or lower end of the stent 3~12 months after the first stent-insertion due to progression of the tumor.The third stent was inserted in 2 patients 10 months and 13 months respectively after the second stent insertion (19 months and 25 months respectively after the first stent insertion) due to the over-growith of granulomatous tissue at the upper end.In one patient having synchronous middle and lower esophageal carcinoma,2 stents were inserted simultaneously.In another aged female patient,second stent was inserted 3 days after the first stent insertion due to complicated esophago-tracheal fistula.Results:Life quality improvement and survival prolongation were obtained in 6 patients due to repeated esophageal stent insertion.In two patients over 50 months of survival were achieved with three stents (three times) insertion In the patient with esophago-tracheal fistula,the fistula was sealed up immediately,however,the patient deceased one week later due to massive hemorrhage of gastro-intestinal tract.Conclusions:Repeated and multiple stent-insertion could be used in the treatment of progression of tumor after primary stent insertion for malignant esophageal stricture.