Schaer J, Katon R M, Ivancev K, Uchida B, Rösch J, Binmoeller K
Department of Medicine, Oregon Health Sciences University, Portland 97201-3098.
Gastrointest Endosc. 1992 Jan-Feb;38(1):7-11. doi: 10.1016/s0016-5107(92)70322-8.
Six patients with high-grade malignant esophageal obstruction were treated with silicone-coated metallic self-expanding esophageal stents (Z stents). Endoscopic placement of stents was well tolerated. All patients achieved excellent palliation, defined by a decrease of at least two dysphagia grades, which was sustained. Complications occurred during follow-up in four patients and included stent migration, silicone disruption with tumor ingrowth, food impaction, and perforation (discovered at autopsy) at the distal stent site. Three of the four complications were promptly treated by endoscopic or radiologic intervention. Recent modification in stent design and placement technique will hopefully reduce complications. The self-expanding stent has several theoretical advantages over the rigid plastic stent and Nd:YAG laser for palliation of obstructing esophageal malignancy.
6例患有高级别恶性食管梗阻的患者接受了硅酮涂层金属自膨式食管支架（Z型支架）治疗。内镜下放置支架耐受性良好。所有患者均实现了极佳的姑息治疗效果，即吞咽困难等级至少降低两级且效果持续。4例患者在随访期间出现并发症，包括支架移位、硅酮破裂伴肿瘤长入、食物嵌塞以及支架远端部位穿孔（尸检时发现）。4例并发症中的3例通过内镜或放射介入治疗得到及时处理。近期支架设计和放置技术的改进有望减少并发症。与刚性塑料支架和钕钇铝石榴石激光相比，自膨式支架在缓解食管恶性梗阻方面具有若干理论优势。
