Choi Eugene K, Song Ho-Young, Kim Jae Wook, Shin Ji Hoon, Kim Kyung Rae, Kim Jong Hoon, Kim Sung-Bae, Jung Hwoong-Yong, Park Seung-Il
Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea.
J Vasc Interv Radiol. 2007 Jul;18(7):888-95. doi: 10.1016/j.jvir.2007.04.017.
To describe the authors' experience with self-expandable covered metallic stents in 16 patients with malignant and benign cervical esophageal strictures.
Sixteen expandable covered metallic stents were placed with fluoroscopic guidance in 16 patients (14 men, two women; mean age, 60 years; age range, 26-75 years) with malignant and benign strictures of the cervical esophagus. The causes of strictures were ingestion of corrosive agents (n = 3), biopsy-proved squamous cell carcinoma (n = 12), and postsurgical scarring (n = 1). The mean dysphagia scores at presentation were compared with those after stent placement by using the Wilcoxon signed rank test.
Stent placement was technically successful in all patients. The reduction in the mean dysphagia score after stent placement was statistically significant (P = .0327). All patients complained of mild to severe foreign body sensation, with four reporting severe pain necessitating immediate stent removal. With the exception of one patient with limited follow-up, complications requiring intervention occurred in all patients, including migration in nine patients and tissue hyperproliferation in two. Of the 12 patients with a malignant stricture of the esophagus, four patients eventually underwent gastrostomy for the placement of a feeding tube and one patient underwent surgery. All four patients with a benign cervical stricture failed to achieve long-lasting improvement with temporary stent placement.
Although the placement of covered metallic stents in the cervical esophagus provides adequate initial palliation, it is associated with poor patient tolerance and a high complication rate.
描述作者使用自膨式覆膜金属支架治疗16例恶性和良性颈段食管狭窄患者的经验。
在透视引导下，为16例（14例男性，2例女性；平均年龄60岁；年龄范围26 - 75岁）患有颈段食管恶性和良性狭窄的患者放置了16个可膨胀覆膜金属支架。狭窄原因包括腐蚀性物质摄入（n = 3）、活检证实的鳞状细胞癌（n = 12）和术后瘢痕形成（n = 1）。使用Wilcoxon符号秩和检验比较置入支架前后的平均吞咽困难评分。
所有患者的支架置入技术均成功。支架置入后平均吞咽困难评分的降低具有统计学意义（P = .0327）。所有患者均主诉有轻至重度异物感，4例报告有严重疼痛，需要立即取出支架。除1例随访受限的患者外，所有患者均出现需要干预的并发症，包括9例支架移位和2例组织过度增生。在12例食管恶性狭窄患者中，4例最终接受了胃造瘘术以放置喂食管，1例接受了手术。4例良性颈段食管狭窄患者通过临时置入支架均未实现长期改善。
尽管在颈段食管置入覆膜金属支架可提供充分的初始姑息治疗，但患者耐受性差且并发症发生率高。
