Bethge N, Knyrim K, Wagner H J, Starck E, Pausch J, Kleist D V
Department of Internal Medicine IV, Hospital Neukölln, Germany.
Endoscopy. 1992 Jun;24(5):411-5. doi: 10.1055/s-2007-1010509.
We sought to determine whether the application of a self-expanding metal stent enables palliation of malignant dysphagia with minimal risk. The results of pilot studies from two centers are reported. We treated 8 inoperable patients with a 14 mm self-expanding metal stent (Wallstent). The stent was applied without general anesthesia under mild i.v. sedation. The procedure was successful in all cases. No side effects were noted. In one patient, tumor ingrowth through the meshes of the stent occurred. This patient was additionally treated with a percutaneous gastrostomy. One patient experienced tumor overgrowth of the proximal end, necessitating laser treatment. Three patients were still alive after three months. The mean number of cumulative endoscopic interventions per patient was 2.2 (SD: +/- 2; median 2). The mean observation time was 10.7 weeks +/- 2 (median 12). Dysphagia was graded from 0 (normal swallowing) to 4 (inability to swallow saliva). Dysphagia was significantly (p less than 0.0005) reduced from grade 3.1 (SD: +/- 0.35) to 0.5 (SD: +/- 0.5) immediately after stenting. 62.5% of the patients were able to manage a virtually normal diet (in one of these patients dysphagia recurred six weeks after stent placement due to tumor ingrowth). Six patients (75%) were able to ingest all necessary calories orally. The application of a 14 mm self-expanding metal stent in cases of inoperable malignant esophageal obstruction seems to offer safe and effective palliation of malignant dysphagia.
我们试图确定自膨式金属支架的应用能否在风险最小的情况下缓解恶性吞咽困难。本文报告了来自两个中心的初步研究结果。我们用14毫米自膨式金属支架（Wallstent）治疗了8例无法手术的患者。在轻度静脉镇静下，未实施全身麻醉即应用了支架。所有病例手术均成功。未观察到副作用。1例患者出现肿瘤长入支架网孔。该患者另外接受了经皮胃造口术治疗。1例患者近端出现肿瘤过度生长，需进行激光治疗。3例患者3个月后仍存活。每位患者累积内镜干预的平均次数为2.2次（标准差：±2；中位数2）。平均观察时间为10.7周±2（中位数12）。吞咽困难程度从0级（正常吞咽）到4级（无法吞咽唾液）进行分级。支架置入后，吞咽困难程度从3.1级（标准差：±0.35）显著（p<0.0005）降至0.5级（标准差：±0.5）。62.5%的患者能够维持几乎正常的饮食（其中1例患者在支架置入后6周因肿瘤长入吞咽困难复发）。6例患者（75%）能够经口摄入所有必需的热量。对于无法手术的恶性食管梗阻病例，应用14毫米自膨式金属支架似乎能安全有效地缓解恶性吞咽困难。
