新型可回收全覆膜镍钛合金支架治疗难治性食管良性狭窄  

A new retrievable nitinol alloy stents for treatment of refractory benign esophageal strictures

作　　者：李小海[1] 胡祎[1] 杨弘[1] Amos Ela Bella 傅剑华[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心胸科,广州510060

出　　处：《中华胃肠外科杂志》2011年第11期875-878,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省科技厅省部产学研合作专项（2008B090500195）;广州市科技局支撑计划（2060402）

摘　　要：目的探讨自行设计的新型可回收抗反流全覆膜镍钛合金支架治疗难治性食管良性狭窄的疗效。方法2009年11月至2011年5月间中山大学肿瘤防治中心胸科采用新型支架治疗难治性食管良性狭窄患者8例。在支架置入术后第1、7、30和60天以及拔除支架术后1、2、3和6个月，进行胃镜和食管吞钡检查，评价患者吞咽功能改善及并发症发生情况。结果8例患者均成功置入新型支架．术后吞咽功能较术前明显改善（P〈0．05）。经9个月的中位随访，已拔除支架6例，其吞咽功能亦较术前明显改善（P〈0．05）：支架继续留置2例，其中1例支架置入术后已15个月，目前仍进普通饮食：另1例支架置入术后2个月吞咽功能较术前改善．但3个月后吞咽功能减退至术前水平。8例患者远期吞咽功能改善率为7／8。术后再狭窄1例：支架脱落2例：肉芽过度增生3例，其中支架覆膜破裂致肉芽向内生长2例。结论新型可回收全覆膜镍钛合金支架置入食管良性狭窄术后和拔除支架后吞咽功能明显改善．远期再狭窄发生率低：但支架脱落发生率仍较高．支架覆膜材料易破裂．仍需进一步改进。Objective To explore long-term effect of the treatment of refractory benign esophageal strictures with a novel retrievable fully covered stent made of nitinol alloy. Methods From November 2009 to May 2011, the stents were placed in 8 patients with refractory benign esophageal strictures in the Department of Thoracic Surgery at the Cancer Center of Sun Yat-sen University. Esophagogastroduodenoscopies and barium swallow examinations were performed respectively on the 1st, 7th, 30th, 60th day after implantations of the stents and 1,2,3,6 months or even longer after removal of the stents in order to assess the long-term effect on the improvement of dysphagia and the development of complications. Results The stents were successful deployed in all the patients. The dysphagia scores were improved instantly and significantly as compared to the preoperative scores （P〈0.05）. Seven patients had long-term improvement of dysphagia. The dwelling time of all the stents ranged from 4 to 60 weeks, with a median of 16.8 weeks. Six patients had their stent removed after a dwelling time of 4 to 18 weeks （median 9.7 weeks）. The follow-up period was 1.5-9 months （median 6.1 months）. The improvement of dysphagia was also significant during follow-up after removal of the stentsiP〈0.05）. At the most recent follow up, two patients still had the stent in place. The first one has already been followed up for 15 months and was still on regular diet. The other one experienced improvement of dysphagia score up to two months after placement, but downgraded to 3 by the third month. Relapse of stenosis occurred in 1 patient, migration in 2 patients, and tissue hyperplasia in 3 patients, of whom 2 developed inward growth of granulation tissue due to the rupture of the covering membrane. Conclusions The new retrievable fully covered stent made of nitinol alloy significantly improves the swallowing function of patients with intractable benign esophageal strictures after implantation and after removal of the stents, with low inciden

关 键 词：食管良性狭窄 支架 吞咽功能 并发症 

分 类 号：R655.4[医药卫生—外科学]