Szentpáli Károly, Palotás András, Lázár György, Paszt Attila, Balogh Adám
Department of Surgery, Albert Szent-Györgyi Medical and Pharmaceutical Center, University of Szeged, Hungary.
Dysphagia. 2004 Winter;19(1):22-7. doi: 10.1007/s00455-003-0018-6.
Access to expensive equipment and costly self-expanding metal endoprostheses is limited in some regions where unresectable esophageal cancer is not infrequent. The aim of this study was to review the long-term results of palliation of malignant esophageal obstruction using low-priced conventional plastic stents. One hundred sixty-nine patients with dysphagia due to inoperable esophageal cancer underwent esophageal intubation under endoscopic control alone, without general anesthesia, by the pulsion method. Stents mounted on their delivery device were inserted over an endoscopically placed guide wire. Improvement in swallowing was seen in all patients. Dysphagia scores have improved from 3.64 +/- 0.21 to 1.08 +/- 0.17. Major early procedure-related morbidity was high at 0.6% with one intramural perforation (no transmural perforation at all). Minimal mucosal bleeding was seen with 72 cases (42.6%). Procedure-related mortality was 0%. Late procedure-related complications requiring further endoscopic procedures occurred in 8.2% (tube occlusion: 5.3%, tube dislocation: 2.9%). Our 7-day mortality was 0% and 5 patients died within 30 days, usually from the disease itself. Those surviving the procedure (more than 7 days) had a mean survival of 209 days. Esophageal plastic stents can be accurately and safely placed under direct endoscopic control with lower costs. Therefore, endoscopic intubation remains a useful palliative treatment for patients with unresectable carcinoma of the esophagus.
在一些不可切除食管癌并不罕见的地区，获取昂贵设备和成本高昂的自膨式金属内支架受到限制。本研究的目的是回顾使用低价传统塑料支架缓解恶性食管梗阻的长期结果。169例因无法手术的食管癌导致吞咽困难的患者，在仅内镜控制下、无全身麻醉的情况下，通过推送法进行食管插管。将安装在输送装置上的支架经内镜放置的导丝插入。所有患者吞咽情况均有改善。吞咽困难评分从3.64±0.21改善至1.08±0.17。早期主要的与操作相关的并发症发生率较高，为0.6%，有1例壁内穿孔（无全层穿孔）。72例（42.6%）出现轻微黏膜出血。与操作相关的死亡率为0%。需要进一步内镜操作的晚期与操作相关的并发症发生率为8.2%（管腔阻塞：5.3%，支架移位：2.9%）。我们的7天死亡率为0%，5例患者在30天内死亡，通常死于疾病本身。术后存活（超过7天）的患者平均生存时间为209天。食管塑料支架可在内镜直接控制下准确、安全地放置，成本较低。因此，内镜插管仍然是不可切除食管癌患者有用的姑息治疗方法。
