Neuhaus H, Hoffmann W, Dittler H J, Niedermeyer H P, Classen M
Department of Internal Medicine, Technical University of Munich, Germany.
Endoscopy. 1992 Jun;24(5):405-10. doi: 10.1055/s-2007-1010508.
Eleven self-expanding metal stents were perorally implanted in ten patients with locally advanced malignant obstruction of the esophagus. After bougienage of the strictures, the stents were painlessly inserted and properly released by means of an 18 French gauge delivery catheter. In all cases, the endoprostheses expanded to a diameter of 14-20 mm and achieved immediate improvement of dysphagia. One perforation was seen after a single session of dilatation and subsequent stent insertion. No other early complication was observed. After a median follow-up of 74 days (Range, 33-252 days), one of eight patients is still alive and 7 died of non-procedural causes. The grade of dysphagia improved from a mean of 2.9 to a mean of 1.6 and 2.0, respectively, depending on the follow-up period (scale 0-4). Esophageal reobstruction occurred in four patients due to food impaction (two patients) or tumor ingrowth into the stent through the wire mesh (two patients). Recanalisation of the obstructed stent lumen was achieved by endoscopic irrigation (two patients), laser therapy only (one patient) or diathermia with subsequent insertion of a conventional plastic endoprosthesis into the metal stent (one patient). The initial results are promising. The delivery system, the wide-bore diameter, the macroporous configuration and the low mass of the self-expanding stents would seem to be associated with a less traumatic insertion procedure and a lower rate of stent migration as compared with conventional prostheses. Technical improvement may be required for prevention of tumor infiltration. Controlled trials are warranted to determine the future role of metallic stents for palliation of esophagocardial tumors.
11个自膨式金属支架经口植入10例局部晚期食管癌性梗阻患者体内。在对狭窄部位进行探条扩张后，通过一根18法式输送导管将支架无痛插入并正确释放。所有病例中，内置假体均扩张至直径14 - 20毫米，吞咽困难立即得到改善。在单次扩张及随后的支架置入后出现1例穿孔。未观察到其他早期并发症。中位随访74天（范围33 - 252天）后，8例患者中有1例仍存活，7例死于非手术相关原因。根据随访时间不同，吞咽困难分级分别从平均2.9改善至平均1.6和2.0（0 - 4级）。4例患者出现食管再梗阻，其中2例因食物嵌塞，2例因肿瘤通过金属丝网长入支架。通过内镜冲洗（2例）、单纯激光治疗（1例）或透热疗法并随后在金属支架内插入传统塑料内置假体（1例）实现了梗阻支架管腔的再通。初步结果令人鼓舞。与传统假体相比，自膨式支架的输送系统、大口径、大孔结构和低质量似乎与创伤性较小的插入操作及较低的支架移位率相关。可能需要技术改进以预防肿瘤浸润。有必要进行对照试验以确定金属支架在缓解食管心脏肿瘤方面的未来作用。
