Morgan R, Adam A
Department of Radiology, St. George's Hospital, London, UK.
J Vasc Interv Radiol. 2001 Mar;12(3):283-97. doi: 10.1016/s1051-0443(07)61906-x.
The majority of malignant and benign strictures in the esophagus and GI tract can be treated with use of minimally invasive alternatives to surgery such as balloon dilation or metallic stents. Virtually any obstructing lesion in the esophagus, stomach, duodenum, colon, and rectum can be treated with these methods with use of interventional radiologic or endoscopic techniques. In general, metallic stents are reserved for malignant strictures and balloon dilation is indicated for benign lesions. Patients with malignant esophageal fistulas and perforations can be palliated effectively and promptly by sealing the fistula or leak by deployment of a covered stent. Patients with malignant disease may benefit from a treatment regime that includes metallic stent placement, chemotherapy, radiation therapy and/or brachytherapy, although the efficacy of such combined therapies has yet to be defined. Further refinements to stent design are required. The ideal stent would be resistant to tumor ingrowth and migration. Placing a coating material on uncovered stents to prevent tumor ingrowth may achieve these aims. Finally, a biodegradable stent that dissolves before the development of intimal hyperplasia might enable stents to be used to treat benign strictures.
食管和胃肠道的大多数恶性和良性狭窄可以通过使用诸如球囊扩张或金属支架等手术的微创替代方法来治疗。实际上，食管、胃、十二指肠、结肠和直肠中的任何阻塞性病变都可以通过介入放射学或内镜技术使用这些方法进行治疗。一般来说，金属支架用于恶性狭窄，球囊扩张适用于良性病变。患有恶性食管瘘和穿孔的患者可以通过部署覆膜支架封闭瘘口或漏口而得到有效且迅速的姑息治疗。患有恶性疾病的患者可能受益于包括金属支架置入、化疗、放疗和/或近距离放疗的治疗方案，尽管这种联合治疗的疗效尚未确定。需要对支架设计进行进一步改进。理想的支架应能抵抗肿瘤向内生长和迁移。在未覆膜支架上放置涂层材料以防止肿瘤向内生长可能实现这些目标。最后，一种在内膜增生发展之前溶解的可生物降解支架可能使支架能够用于治疗良性狭窄。
