带膜食管支架置人术32例临床疗效观察

目的：探讨带膜食管支架置入术治疗食管癌性狭窄和食管-气管瘘的临床效果。方法：32例晚期食管癌性狭窄和食管-支气管瘘患者，均无手术指征，术前已行内镜和X线钡剂造影检查明确病变部位和性质。术中应用利多卡因胶浆行咽喉部麻醉，置开口器，透视下将超滑导丝与5F导管送入食管内，撤出导丝，经导管注入造影剂确定病变上下端，体表用铅条标记定位病变狭窄区；导丝及导管进入胃腔内，置换不折钢丝，沿钢丝将支架送至病变部位，X线透视下缓慢释放，观察临床疗效。结果：所有患者吞咽困难均显著改善，食管-气管瘘患者呛咳显著缓解。但患者均有不同程度的胸痛、胸部异物感，平均缓解时间2周，支架术后平均存活13个月，并发症有疼痛、再狭窄、支架移位、胃内容物反流、出血、支架嵌顿填塞等。结论：带膜食管支架能显著缓解食管癌患者的进食困难及食管-支气管瘘呛咳、肺内感染、严重营养不良症状，提高患者的生活质量，延长生存时间。对于重度吞咽困难而又失去手术机会或拒绝接受手术治疗的食管癌患者，经口腔在X线透视下放置带膜食管支架是一种操作安全可靠、微创、简单易行、见效快、费用相对低廉的治疗方法。

Clinical efficacy of 32, cases with esophageal cancer treated with membrane - esophage- al stenting

Objective： To investigate the clinical effects of membrane - esophageal stenting for esophageal stenosis and esophageal - bronchial fistula. Methods： All 32 patients with esophageal carcinoma confirmed by endoscopic and pathologic diagnosis, who had no surgical indications, were included. All patients had a operation of esophageal stent implantation with a membrane in the X - ray because of esophageal stenosis and esophageal - bronchial fistula. The clinical efficacy and complications was observed. Results： Dysphagia of all the patients was significantly improved, cough of patients sufferd esophagotracheal fistula was disappeared, but the patients had chest pain and foreign body sensation in the chest, the average remission time was 2 weeks, median survival after stenting was 13 months. The complications were pain, restenosis, stent migration, reflux of gastric contents, bleeding, stent incarcerated or block. Conclusion ： Esophageal stent implantation with a membrane can significantly release the dysphagia, lung infection, se- vere malnutrition and improve patient, squality of life and prolong survival time. Esophageal stent implantation with a membrane is a reliable, minimally invasive, simple, quick and relatively low cost of treatment for the patients who have severe swallowing problem,lost the opportunity of surgery or refuse surgical treatment.