可回收自膨防返流覆膜食道支架治疗食道贲门失弛缓症  

The treatment of achalasia with reclaimable self-expanded esophageal membranous stents preventive of countercurrent

作　　者：向述天[1] 李占峰 刀永功[1] 贾立中[1] 胡正琴[1] 

机构地区：[1]昆明医学院第一附属医院影像中心介入室,昆明650032 [2]云南省农垦总局第一职工医院

出　　处：《医学信息（手术学分册）》2007年第6期499-501,共3页Medical Information Operations Sciences Fascicule

摘　　要：目的探讨国产可回收自膨防返流覆膜食道支架在治疗食道贲门失驰缓症的临床应用。方法支架为南京微创医学科技有限公司产MTN-S型形状记忆镍钛合金可回收自膨防返流覆膜杯口球头食道支架,规格80/20mm(长度/直径),交替导丝,超硬导丝,导管,支架回收器。23例患者,钡餐确诊,最大年龄64岁,最小15岁,男性19人,女性4人。病程最长29年,最短12个月。狭窄程度1.0～5.0mm。在电视透视下,将导丝置入胃内(较困难者在胃镜帮助下置入导丝),沿导丝将置入器缓慢送入,支架远端置于胃内,近端在狭窄上方,开始释放,取出导丝和置入器,将回收线拉紧经鼻腔固定于耳廓上。两周时取出并复查钡餐。结果全部病例支架置入一次成功,术后感胸骨后钝痛,持续5～7d,用止痛药能缓解。有1例术后3d支架移入狭窄上方食道内,有2例分别于术后7d和12d滑入胃内,取出支架后重新置入。有1例患者术后1h出现恶心呕吐、疼痛性休克,经抢救无生命危险。所有病例两周时能顺利取出支架,未出现支架嵌顿现象,食道钡餐示狭窄有不同程度开放,达到15mm左右,解除了咽下困难。术后3个月、6个月、12个月钡餐或电话随访,最长者达43个月仍未出现咽下困难。结论支架扩张是随着支架进入体内后温度逐渐升高而扩张,作用于食道四周的力量均匀,疼痛轻微,不易引起食道破裂和出血,取出支架容易。该手术安全、简便、禁忌证少,由于国产支架大幅降低了费用,值得推广应用。Objective To investigate the value of the reclaimable self-expanded esophageal membranous stents preventive of countercurrent in the treatment of the achalasia.Methods Made by MICRO-TECH（NANJING）CO.LTD,the rememberable nickel-titanium stents were MTN type（20/80 mm）lined with membrane which can be reclaimable and self-expanded.The wires were substituting and super-hard.23 patients diagnosised with barium meal were between the ages of 15-64 years,of which the disease courses were between 12 months and 29 years.The stenosis was 1.0-5.0 mm.No meal 4 hours before the operation and the pharynx was anaesthetic for 10-15 minutes.654-2 of 20 mg,atropine of 0.5 mg or stabilizer of 10 mg was injected.Under fluoroscopy the wire was sent into the stomach（gastroscope is needed if very difficult）and the introducer slowly sent in along the wire.The distal part of the stent was put in the stomach and the nearer part above the stenosis,and after the stent was released,the reclaimable thread was pulled tight and tied on one of the ears.One hour after the operation warm liquid diet was needed,barium meal examination carried out the second day,semi-liquid diet needed 3 days later and ordinary diet one week later.The stents were taken out two weeks later and barium meal examination needed again.Results The operation was successful once in all patients.Dull pain lasting for 5-7 days was felt behind the sternum post-operatively,which could be relieved with pain killer.One patient had nausea,vomiting and shock due to pain 1 hours after operation,but recovered after emergent treatment.All the stents were taken out without difficulties,the stenosis of the esophagus was enlarged to different extents at least above 15 mm when examined with barium meal and the swallowing difficulties were solved.The stents in three patients slipped into the stomaches 13 days after operation.The cardia of the esophagus open wide and no stenosis could be found during the 3-43 months’ follow-up.Conclusions But expansion with the stent is gradual,ca

关 键 词：食道 贲门失弛缓症 可回收自膨支架 

分 类 号：R573.7[医药卫生—消化系统]