Shen Qi, Xu Jian-Jun, Ren Li-Jun, Jiang Zhong-Pu
Department of Interventional Radiology, The First People's Hospital of Kaifeng, Kaifeng, Henan, 475000, PR China.
Ai Zheng. 2003 Oct;22(10):1118-20.
BACKGROUND & OBJECTIVE: Dysphagia is the main clinical symptom of the patients with esophageal carcinoma. The stent placement in esophagus is an effective method to resolve dysphagia.There are many types of stents. Through comparing observation of the stents made in China, which is the stainless steel "Z" stent, the Ni-Ti wire mesh-like stent, and the covered or uncovered-stent, the authors analyzed the clinical application of various types of esophageal stents in the treatment of malignant esophageal stricture.
The various types of esophageal stents were implanted into 40 patients with esophageal carcinoma. 13 cases for stainless steel "Z" stents, 27 cases for Ni-Ti wire mesh-like stents(24 cases were the covered stents and 16 cases were uncovered). All the patients were not operated with the dilation of balloon before stent placement.
The esophageal stents were successfully implanted into 40 patients without complication of operation. Stainless steel "Z" stent were all dilated immediately at the time of operation, and all the 13 patients had obvious intra-breastbone pain after operation, which lasted 10-20 days. Although Ni-Ti wire mesh-like stents could not dilate completely in operation, all these can be dilated completely after 1 to 3 days; nine cases of them had obvious intra-breastbone pain, which lasted 3-5 days. In all these, 7 cases were the covered-stents and 2 cases uncovered. In 9 cases, tracheoesophageal fistulas were blocked completely. There was barium sulphate retention between the covered-stent implanted to the patients without tracheoesophageal fistula and the dilated esophagus.
The clinical adaptability of the Ni-Ti wire mesh-like stent is better than that of the stainless steel "Z" stent. For the patients with tracheoesophageal fistula, the first choice is covered-stent, while for the patients without tracheoesophageal fistula, uncovered-stent is better. The dilation of balloon is not necessary before the stent placement.
吞咽困难是食管癌患者的主要临床症状。食管支架置入是解决吞咽困难的有效方法。支架种类繁多。通过对国产的不锈钢“Z”形支架、镍钛丝网状支架以及覆膜或非覆膜支架进行对比观察,作者分析了各类食管支架在治疗恶性食管狭窄中的临床应用。
将各类食管支架植入40例食管癌患者体内。13例植入不锈钢“Z”形支架,27例植入镍钛丝网状支架(其中24例为覆膜支架,16例为非覆膜支架)。所有患者在支架置入前均未行球囊扩张术。
40例患者食管支架均成功置入,无手术并发症。不锈钢“Z”形支架在手术时均立即扩张,13例患者术后均有明显胸骨后疼痛,持续10 - 20天。镍钛丝网状支架虽在手术时不能完全扩张,但1至3天后均能完全扩张;其中9例有明显胸骨后疼痛,持续3 - 5天。其中,7例为覆膜支架,2例为非覆膜支架。9例患者的气管食管瘘完全封堵。在未合并气管食管瘘的患者植入覆膜支架与扩张后的食管之间有硫酸钡残留。
镍钛丝网状支架的临床适应性优于不锈钢“Z”形支架。对于合并气管食管瘘的患者,首选覆膜支架;对于未合并气管食管瘘的患者,非覆膜支架更佳。支架置入前无需行球囊扩张术。