支架置入或经皮穿刺胃造瘘术治疗颈段高位食管狭窄20例  

Application of metallic stent implantation or percutaneous gastrostomy for high level cervical esophageal strictures:Report of 20 cases

作　　者：李凯滨[1] 黄肇云[1] 罗剑云[1] 陈亚炎[1] 

机构地区：[1]广东省肇庆市第一人民医院肿瘤科,肇庆526021

出　　处：《中国微创外科杂志》2006年第1期34-36,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨支架置入或经皮穿刺胃造瘘在颈段高位食管狭窄治疗中的可行性和安全性。方法食管狭窄位于C7～T3 13例，在X线监视下经口置入球型单丝编织带膜的镍钛合金支架；食管狭窄位于C7以上7例，在内镜（1例）或X线透视引导下（6例）经皮穿刺胃造瘘术。结果手术全部成功，无严重并发症。置入食管内支架13例，术后吞咽困难程度改善0级10例，Ⅰ级3例。5例食管一气管瘘封堵成功。2例术后l周支架向下轻度移位，但仍能覆盖病变全长，未做处理。支架置入11例随访l～30个月，平均18个月，食管再狭窄3例，死亡8例，无支架嵌入气管诱发食管一气管瘘发生。经皮穿刺胃造瘘术7例，均在术后2d经饲管注入胃肠营养液及流质食物。1例术后1周出现造瘘口周围红肿感染，1例5个月造瘘管松动，无腹腔感染、腹膜炎和造瘘口内瘘等并发症。经皮穿刺胃造瘘7例随访1～18个月，5例死亡。结论颈段高位食管狭窄并非内支架置入治疗禁区。透视引导下经皮穿刺胃造瘘术，安全性高，并发症少，可作为改善生活质量、延长生存时间的首选治疗方法。Objective To evaluate the feasibility and safety of interventional microinvasive techniques in the management of high level cervical esophageal strictures. Methods Among 20 cases of high level cervical esophageal strictures, 13 cases of strictures at the level of C7 - T3 were given an oral placement of nitinol metal stents woven by single thread under fluoroscopic guidance, while 7 cases of strictures at the level of C7 and above were given a percutaneous gastrostomy （PG） under endoscopic or fluoroscopic guidance. Results All the operations were successfully accomplished without complications. Out of 13 cases of intraesophageal stent implatation, the improvement of dysphagia was classified as grade 0 in 10 cases and as grade I in 3 cases. Esophago - tracheal fistula was completed occluded in 5 cases. Slight downward stent, shift was found in 2 cases and no further management was carried out. Follow - up in 11 cases for 1 - 30 months （mean, 18 months） revealed 3 cases of recurrence of esophageal stricture and 8 fatal cases. No stent - induced esophago - tracheal fistula occurred. Of 7 cases of percutaneous gastrostomy, liquid diet was given 2 days after operation. Infection with redness and swelling in the area of fistula wound was noted in 1 case at 1 week postoperatively and the fistula tube was found loosened in 1 case at 5 months postoperatively. No intraabdominal infection, peritonitis, or internal fistula occurred. Follow - up in 7 cases for 1 - 18 months showed 5 fatal cases. Conclusions Stent implantation should not be contraindicated in patients with high level cervical stricture of esophagus. Radiologically guided Dercutaneous gastrostomy is safe and feasible, which is preferred as the first choice of treatment.

关 键 词：颈段 食管狭窄 金属支架 胃造瘘术 

分 类 号：R655.4[医药卫生—外科学]