食管支架治疗恶性食管狭窄并发症分析与处理

目的：探讨国产被膜镍钛合金网状支架治疗食管、贲门恶性狭窄并发症原因与处理及支架植入相关技术。方法：本组20例患者支架植入前均先行食管造影，测量病变长度，取X线正位片上病变长度减去放大率21.5%±2.45，作为病变实际长度。选择大于测得病变实际长度4cm支架，支架直径大于病变段以上正常食管腔直径的15%~20%，一般以16~20mm为宜。在超滑导丝、导引导管引入超硬导丝将支架植入预定部位，狭窄严重者先予球囊扩张再植入支架，亦有先植入支架后辅以球囊扩张。结果：20例患者共植入18枚支架，2例因食管腔完全闭塞，导丝无法通过狭窄段而放弃。成功率为90%。支架植入后占位效应引发的胸骨后疼痛16例、气管支气管压迫性胸闷呼吸困难2例，食物嵌顿2例；出血1例，支架移位1例，再狭窄1例。结论：食管支架植入治疗食管恶性狭窄有效，认识和掌握并发症原因与处理方法及支架植入相关技术是减少并发症的关键。

Analysis of the complications of malignant esophagus stenosis from stenting

Objective: To discuss the cause and treatment of the complications of malignant esophagus and gastric cardia stenosis by introducing the domestic-made nickel-titanium alloy coated mesh stent(plank) and the correlative plantation techniques. Methods: Twenty patients were treated with this method. The extent of stenosis were measured by esophagogram. The stents, about 4cm longer than the length of lesion, and 15%~20% larger than the normal esophagus above the lesion, usually 16~20mm were chosen. The stent was introduced to the chosen location under the guide of super-smooth wire, super-hard wire and catheter. The severe stenosis was expanded by balloon catheter before or after stent plantation. Results: Among the 20 patients, we successfully planted stent in 18 patients, and failed in 2 patients due to severe esophageal obstruction. The success rate is high up to 90%. Sixteen patients appeared pain behind the sternum for mass effect, 2 patients showed chest distress and dyspnea for tracheal bronchus compression, 2 cases had food incarceration, 1 case had bleeding, 1 had stent translocation, and 1 had restenosis. Conclusion: The stent plantation is an effective method for malignant esophagus stenosis, and can display the cause of complications. The correlative plantation technique is the key to reduce the incidence of complications.