Pennathur Arjun, Chang Andrew C, McGrath Kevin M, Steiner Gregory, Alvelo-Rivera Miguel, Awais Omar, Gooding William E, Christie Neil A, Gilbert Sebastien, Landreneau Rodney J, Luketich James D
Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Ann Thorac Surg. 2008 Jun;85(6):1968-72; discussion 1973. doi: 10.1016/j.athoracsur.2008.01.095.
The new generation of expandable plastic esophageal stents (Polyflex; Boston Scientific, Natick, MA), combine the features of plastic and self-expanding metallic stents. The main objective of this study is to evaluate our initial experience with Polyflex expandable stents in the treatment of esophageal disease from two institutions.
A total of 58 Polyflex stents were placed in 38 patients over a two-year period. There were 24 men and 14 women, with a median age of 63 years (range, 25 to 83). The most common indication for placement was an esophageal stricture in 25 patients (66%); other causes included leak in 8 (21%) and tracheoesophageal fistula (TEF) in 5 (13%). We evaluated the hospital course, complications, and outcomes.
The median postoperative stay was one day. Complications included migration in 38 stents (63%) (28 patients; 73%), retrosternal chest discomfort in nine, reflux in four, airway obstruction in one, and food impaction in three. Continued leak or a persistent TEF occurred in five patients (38%). Reintervention was required predominantly due to migration of the stent at a mean interval of 46 days (range, 1 to 353). Patients with dysphagia improved significantly with dysphagia scores (1 = no dysphagia; 5 = unable to swallow saliva) improving from 3.44 to 2.15 (p < 0.0001).
Polyflex stents were effective in the relief of dysphagia due to strictures. They were less effective in esophageal perforations or leaks. Their primary disadvantage is a high migration rate and further improvements in design are required to decrease this high incidence of migration.
新一代可扩张塑料食管支架（Polyflex；波士顿科学公司，马萨诸塞州纳蒂克）结合了塑料和自膨胀金属支架的特点。本研究的主要目的是评估我们在两家机构使用Polyflex可扩张支架治疗食管疾病的初步经验。
在两年时间里，共为38例患者置入了58枚Polyflex支架。其中男性24例，女性14例，中位年龄63岁（范围25至83岁）。置入支架最常见的适应证是25例（66%）食管狭窄；其他原因包括8例（21%）漏口和5例（13%）气管食管瘘（TEF）。我们评估了住院过程、并发症及治疗结果。
术后中位住院时间为1天。并发症包括38枚支架（63%）移位（28例患者；73%）、9例胸骨后胸痛、4例反流、1例气道梗阻和3例食物嵌塞。5例患者（38%）持续存在漏口或持续性TEF。再次干预主要是由于支架移位，平均间隔时间为46天（范围1至353天）。吞咽困难患者的吞咽困难评分（1 = 无吞咽困难；5 = 无法吞咽唾液）从3.44显著改善至2.15（p < 0.0001）。
Polyflex支架对缓解狭窄所致吞咽困难有效。对食管穿孔或漏口的效果较差。其主要缺点是移位率高，需要进一步改进设计以降低这种高移位发生率。
