Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA.
Dig Dis Sci. 2010 May;55(5):1344-8. doi: 10.1007/s10620-010-1134-4. Epub 2010 Feb 13.
Refractory benign esophageal strictures (RBES) are defined as those that persist structurally and symptomatically after repeated dilation sessions. Small series have reported favorable outcomes after placement and subsequent removal of Polyflex self-expanding plastic stents (SEPS).
To characterize the outcomes after Polyflex stent placement in patients with RBES.
Outcomes of consecutive patients who underwent Polyflex stent placement for RBES between April 15, 2005 and November 20, 2006 were analyzed retrospectively. The etiology of the stricture, number of dilations prior to initial SEPS placement, size of stent placed, stricture resolution after SEPS removal, cases of stent migration, duration of SEPS placement, time to repeat dilation and/or SEPS replacement after stent removal, and complications were assessed.
Twenty-three Polyflex stents were placed in 13 patients suitable for analysis. The majority of stenoses (11/13) were attributable to anastomotic strictures after curative esophagogastrectomy for esophageal neoplasms. All 11 patients in this group had satisfactory relief of dysphagia to solids determined clinically with indwelling SEPS placement. SEPS migration occurred in seven instances (30% of SEPS placed). Dysphagia remediation after subsequent SEPS removal was observed in only three patients (23%). Placement of a partially covered metal stent within a Polyflex stent was necessary in one case due to epithelial hyperplasia. The mean time for repeat dilation and/or SEPS reinsertion due to recurrent dysphagia after stent removal was 37 days (range 6-120 days).
Polyflex stents provided satisfactory palliation of dysphagia for RBES while in place. However, unplanned SEPS migration and dysphagia recurrence after stent removal were common.
难治性良性食管狭窄（RBES）是指在多次扩张治疗后仍存在结构和症状的狭窄。一些小系列研究报告称，放置和随后取出 Polyflex 自膨式塑料支架（SEPS）后，结果良好。
描述 RBES 患者放置 Polyflex 支架后的结局。
回顾性分析 2005 年 4 月 15 日至 2006 年 11 月 20 日期间因 RBES 接受 Polyflex 支架置入的连续患者的结局。评估狭窄的病因、初始 SEPS 放置前扩张的次数、放置的支架大小、SEPS 取出后狭窄的缓解情况、支架迁移的病例、SEPS 放置的持续时间、支架取出后重复扩张和/或 SEPS 更换的时间以及并发症。
13 例适合分析的患者共放置了 23 个 Polyflex 支架。大多数狭窄（11/13）是由于食管肿瘤根治性食管胃切除术后吻合口狭窄引起的。在这一组中，所有 11 例患者在留置 SEPS 放置后，固体吞咽困难的症状都得到了满意的缓解。在 7 例（SEPS 放置的 30%）中发生了支架迁移。在随后的 SEPS 移除后，只有 3 例（23%）观察到吞咽困难得到缓解。由于上皮过度增生，有 1 例需要在 Polyflex 支架内放置部分覆盖的金属支架。由于支架取出后再次出现吞咽困难而需要重复扩张和/或重新插入 SEPS 的平均时间为 37 天（6-120 天）。
Polyflex 支架在放置时为 RBES 提供了满意的吞咽困难缓解。然而，SEPS 支架迁移和支架取出后吞咽困难复发是常见的。
