Davies N, Thomas H G, Eyre-Brook I A
Department of Surgery, Taunton and Somerset Hospital.
Ann R Coll Surg Engl. 1998 Nov;80(6):394-7.
Until recently, intubation for the palliation of malignant dysphagia has relied upon the insertion of a variety of plastic tubes. Self-expanding metal stents are reported to have a lower complication rate. We have compared the results of Atkinson tube insertion with self-expanding metal stents in patients with inoperable oesophageal carcinoma. From 1990 to 1994 Atkinson tubes were inserted for the palliation of dysphagia from oesophageal cancer, from 1994 onwards self-expanding metal stents were used. Complications, mortality and hospital stay were compared in both groups of patients. In all, 87 patients with inoperable oesophageal carcinoma were treated, 46 with an Atkinson tube and 41 with metal stents. Complications occurred at similar rates in both groups (56% Atkinson tubes, 44% metal stents). There was a significantly higher perforation rate associated with Atkinson tube insertion (8 patients, 17%) compared with metal stents (1 patient, 2.4%, P = 0.02, chi 2). The length of stay was also significantly higher in the Atkinson tube group (median 10 days) compared with the metal stent group (3 days, P < 0.01, Mann-Whitney U test). Mortality rates were similar in both groups. The use of metal stents for the palliation of dysphagia in inoperable oesophageal carcinoma results in a lower perforation rate and a reduced length of stay and they represent a significant advantage over Atkinson tubes.
直到最近，恶性吞咽困难的姑息性插管一直依赖于插入各种塑料管。据报道，自膨式金属支架的并发症发生率较低。我们比较了在无法手术的食管癌患者中插入阿特金森管与自膨式金属支架的效果。1990年至1994年期间，插入阿特金森管以缓解食管癌引起的吞咽困难，从1994年起开始使用自膨式金属支架。比较了两组患者的并发症、死亡率和住院时间。总共治疗了87例无法手术的食管癌患者，46例插入阿特金森管，41例使用金属支架。两组的并发症发生率相似（阿特金森管组为56%，金属支架组为44%）。与金属支架相比，插入阿特金森管的穿孔率明显更高（8例患者，17%），而金属支架组为1例患者，2.4%，P = 0.02，卡方检验）。阿特金森管组的住院时间也明显长于金属支架组（中位数10天），而金属支架组为3天，P < 0.01，曼-惠特尼U检验）。两组的死亡率相似。在无法手术的食管癌患者中，使用金属支架缓解吞咽困难导致较低的穿孔率和缩短的住院时间，与阿特金森管相比具有显著优势。
