Ross William A, Alkassab Firas, Lynch Patrick M, Ayers Gregory D, Ajani Jaffer, Lee Jeffrey H, Bismar Mike
Department of GI Medicine and Nutrition, MD Anderson Cancer Center, Houston, Texas 77030, USA.
Gastrointest Endosc. 2007 Jan;65(1):70-6. doi: 10.1016/j.gie.2006.04.040.
Self-expanding metal stents (SEMS) are touted as the cornerstone of endoscopic palliation of unresectable esophageal cancer. However, usage at MD Anderson has fallen in recent years, despite a greater volume of patients with esophageal cancer.
To compare our more recent experience with that of earlier reported institutional experience and to assess how esophageal stent use has evolved.
A retrospective chart review.
A tertiary referral cancer center.
Ninety-seven patients with malignant dysphagia who had SEMS placed from 2000 to 2003.
Placement of SEMS for malignant disease.
Dysphagia scores, overall survival, and complication rates.
Dysphagia scores improved in 86%, and tracheoesophageal fistula symptoms improved in 90%. Complications were seen in a majority of the patients and major complications in 37%. Ten patients had hematemesis, migrations occurred in 5, and early unexpected deaths in 2. Adenocarcinoma and female sex were factors associated with increased odds of a major complication. Prior chemoradiation, age, stricture location, and length were not associated with complications. Median survival was 77 days.
Noncomparative retrospective single-center study.
SEMS fall short of an ideal palliative method, because complications that require additional intervention are frequent. Usage has declined despite higher numbers of patients with esophageal cancer. However, for patients with tracheoesophageal fistulas, SEMS are the treatment of choice. For patients who are not candidates for chemoradiation or who failed to achieve adequate palliation with such therapy, SEMS offer a viable, albeit imperfect, endoscopic approach.
自膨式金属支架（SEMS）被视为无法切除的食管癌内镜姑息治疗的基石。然而，尽管近年来食管癌患者数量增多，但MD安德森癌症中心的SEMS使用量却有所下降。
将我们近期的经验与早期报道的机构经验进行比较，并评估食管支架的使用情况是如何演变的。
回顾性病历审查。
一家三级转诊癌症中心。
1997年至2003年间接受SEMS置入的97例恶性吞咽困难患者。
为恶性疾病置入SEMS。
吞咽困难评分、总生存率和并发症发生率。
86%的患者吞咽困难评分有所改善，90%的患者气管食管瘘症状有所改善。大多数患者出现并发症，37%出现严重并发症。10例患者出现呕血，5例发生支架移位，2例早期意外死亡。腺癌和女性是与严重并发症几率增加相关的因素。先前的放化疗、年龄、狭窄部位和长度与并发症无关。中位生存期为77天。
非对照性回顾性单中心研究。
SEMS并非理想的姑息治疗方法，因为需要额外干预的并发症很常见。尽管食管癌患者数量增加，但SEMS的使用量仍在下降。然而，对于气管食管瘘患者，SEMS是首选治疗方法。对于不适合放化疗或放化疗未能充分缓解症状的患者，SEMS提供了一种可行的、尽管并不完美的内镜治疗方法。
