Loizou L A, Rampton D, Bown S G
National Medical Laser Centre, University College Hospital, London, United Kingdom.
Gastrointest Endosc. 1992 Mar-Apr;38(2):158-64. doi: 10.1016/s0016-5107(92)70382-4.
Endoscopic intubation has traditionally been considered unsuitable as a means of palliating cervical esophageal carcinomas involving or within 2 cm of the cricopharyngeus sphincter muscle because of the potential problems of foreign body sensation and proximal prosthesis migration. We attempted to palliate eight such patients, three of whom had tracheo-esophageal fistulas by the endoscopic placement of modified Celestin endoprostheses; the floppy funnel of the prosthesis was positioned above the cricopharyngeus in the hypopharynx. Prosthesis placement and fistula occlusion was possible in all patients. Six patients had a significant long-term improvement in their dysphagia, managing a semi-solid (5 patients) or liquid diet (1 patient); two patients did not improve, despite accurate prosthesis placement, because of marked tracheal aspiration. Six patients reported no foreign body sensation; one patient had minor discomfort, and another moderate throat discomfort. Distal prosthesis migration occurred in two patients (replaced in 1 patient). Endoscopic intubation of high cervical esophageal carcinomas with specially modified endoprostheses is feasible and can provide worthwhile palliation of dysphagia and symptoms due to a tracheo-esophageal fistula. Foreign body sensation and proximal prosthesis migration did not prove troublesome.
传统上，内镜插管一直被认为不适用于缓解累及环咽括约肌或距其2厘米以内的颈段食管癌，因为存在异物感和近端假体移位等潜在问题。我们尝试为8例此类患者进行姑息治疗，其中3例患有气管食管瘘，通过内镜放置改良的塞莱斯坦内支架；支架的柔软漏斗部分置于下咽的环咽肌上方。所有患者均成功放置了支架并封闭了瘘口。6例患者的吞咽困难得到了显著的长期改善，能够进食半固体食物（5例）或流食（1例）；2例患者尽管支架放置准确，但因严重的气管误吸而无改善。6例患者表示没有异物感；1例患者有轻微不适，另1例患者有中度咽喉不适。2例患者发生了远端假体移位（1例患者进行了更换）。使用特制改良内支架对高位颈段食管癌进行内镜插管是可行的，能够有效缓解吞咽困难以及气管食管瘘引起的症状。异物感和近端假体移位并未造成麻烦。
