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  

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

作　　者：谢小西[1] 陈益明[1] 周坦峰[1] 严补生 高斌[1] 朱中云[1] 

机构地区：[1]武钢集团鄂钢医院介入放射科,湖北436000

出　　处：《放射学实践》2007年第5期523-526,共4页Radiologic Practice

摘　　要：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。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.

关 键 词：食管狭窄 支架 食管肿瘤 

分 类 号：R735.1[医药卫生—肿瘤]