Gupta N K, Boylan C E, Razzaq R, England R E, Mirra L, Martin D F
Department of Radiology, South Manchester University Hospitals NHS Trust, Withington Hospital, West Didsbury, Manchester M20 2LR, UK.
Eur Radiol. 1999;9(9):1893-7. doi: 10.1007/s003300050943.
The role of self-expanding metallic stents is well established in the palliation of oesophageal stenosis and dysphagia due to primary oesophageal malignancy. However, their role in palliation of dysphagia due to external compressive mediastinal malignancies is not well established. The purpose of this study was to assess the efficacy of self-expanding metallic stents in the palliation of dysphagia due to extrinsic oesophageal compression by mediastinal malignancy. Between January 1995 and January 1998, 21 patients with oesophageal compression due to malignant mediastinal tumours underwent oesophageal stent placement for palliation of dysphagia. Complete data were available in 17 patients (10 men and 7 women). The mean age was 63.5 years (range 46-89 years). A total of 19 stents were placed successfully. The dysphagia grade prior to and after oesophageal stent placement was assessed and the complications documented. Of the 17 patients, 16 reported an improvement in dysphagia. The mean dysphagia score improved from 3.1 prior to treatment to 1.3 after treatment. In 1 patient the stent slipped during placement and another stent was placed satisfactorily. Early complications (within 48 h) in the form of mild to moderate retrosternal chest pain occurred in 5 patients. This was treated symptomatically. Late complications (after 48 h) in the form of bolus impaction occurred in 2 patients. This was successfully treated with oesophagoscopy and removal of bolus. In 2 patients the stent was overgrown by tumour and in one of these an additional stent was placed. In 1 patient incomplete closure of a tracheo-oesophageal fistula was observed. There was no procedure- or stent-related mortality. The mean survival time of this group was 2. 1 months. Self-expanding metallic stents can be safely and effectively used in the palliation of dysphagia due to external mediastinal malignancies.
自膨式金属支架在缓解原发性食管癌所致食管狭窄和吞咽困难方面的作用已得到充分确立。然而，其在缓解纵隔恶性肿瘤外部压迫所致吞咽困难方面的作用尚未明确。本研究的目的是评估自膨式金属支架在缓解纵隔恶性肿瘤所致食管外压性吞咽困难方面的疗效。1995年1月至1998年1月期间，21例因纵隔恶性肿瘤导致食管受压的患者接受了食管支架置入术以缓解吞咽困难。17例患者（10例男性和7例女性）有完整数据。平均年龄为63.5岁（范围46 - 89岁）。共成功置入19枚支架。评估了食管支架置入前后的吞咽困难分级，并记录了并发症。17例患者中，16例报告吞咽困难有所改善。平均吞咽困难评分从治疗前的3.1改善至治疗后的1.3。1例患者在置入过程中支架移位，另一个支架置入满意。5例患者出现早期并发症（48小时内），表现为轻至中度胸骨后胸痛，对症治疗。2例患者出现晚期并发症（48小时后），表现为食物团块嵌塞，经食管镜检查并取出食物团块成功治疗。2例患者的支架被肿瘤过度生长，其中1例又置入了一枚支架。1例患者观察到气管食管瘘未完全闭合。无手术或支架相关死亡。该组患者的平均生存时间为2.1个月。自膨式金属支架可安全有效地用于缓解纵隔恶性肿瘤外部压迫所致的吞咽困难。
