Cordero J A, Moores D W
Albany Medical College, Department of Thoracic Surgery, St. Peter's Hospital, New York, USA.
Am Surg. 2000 Oct;66(10):956-8; discussion 958-9.
Esophageal obstruction from any cause is debilitating. In patients with malignant obstruction palliation to relieve pain and dysphagia is the primary goal. Conventional endoluminal prostheses allow variable palliation. Covered expandable metallic stents with an 18-mm lumen allow improved deglutition. From December 1994 through December 1998, 59 patients underwent placement of self-expanding silicone-covered esophageal stents for esophageal obstruction. There were 36 men and 23 women ranging in age from 41 to 94. All patients underwent esophageal dilation using a flexible gastroscope and Savary bougies. After dilation placement of the stent was performed under fluoroscopic control. Follow-up was complete in all patients. Technical success was achieved in all patients. There was one postoperative death (bronchopulmonary fistula), one migration of the stent requiring removal, and one recurrent obstruction. The remaining stents were well tolerated even in the cervical region (four patients). All patients returned to a diet of solid foods. We conclude that covered self-expanding esophageal metallic stents are technically simple and safe to insert and appear to provide durable excellent palliation of esophageal obstruction due to either benign or malignant conditions.
任何原因引起的食管梗阻都会使人虚弱。对于恶性梗阻患者，缓解疼痛和吞咽困难是主要目标。传统的腔内假体只能提供不同程度的缓解。内径为18毫米的覆膜可扩张金属支架能改善吞咽。从1994年12月至1998年12月，59例患者因食管梗阻接受了自膨式硅酮覆膜食管支架置入术。其中男性36例，女性23例，年龄在41岁至94岁之间。所有患者均使用可弯曲胃镜和Savary探条进行食管扩张。扩张后，在荧光透视控制下置入支架。所有患者均完成随访。所有患者技术上均获成功。术后有1例死亡（支气管肺瘘），1例支架移位需取出，1例复发梗阻。其余支架即使在颈部区域（4例患者）也耐受性良好。所有患者均恢复了固体食物饮食。我们得出结论，覆膜自膨式食管金属支架技术操作简单、插入安全，似乎能为良性或恶性疾病引起的食管梗阻提供持久、良好的缓解。
