Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Dis Esophagus. 2010 Nov;23(8):660-5. doi: 10.1111/j.1442-2050.2010.01077.x.
The efficacy of using self-expanding metallic stent (SEMS) for palliation of symptoms because of tumor recurrence after prior esophagogastrectomy has not been properly assessed despite the well recognized use of SEMS in patients without prior surgery. The aim of this study is to evaluate the efficacy and safety of using SEMS in patients who had prior esophagogastrectomy. The study group included 35 patients with carcinoma of esophagus or cardia documented to have loco-regional recurrence after esophagogastrectomy and in whom SEMS were placed for palliation. The median age was 67 (ranged 41-85). The indications for stenting were dysphagia caused by recurrence at the esophageal anastomosis (n= 4) and in the esophageal remnant (n= 5), or extrinsic compression from mediastinal nodal disease (n= 7); gastric outlet obstruction produced by extrinsic tumor compression (n= 13); and tracheo-esophageal fistulae (n= 6). Forty-three stenting procedures were performed, and the technical success rate was 97.6%. The dysphagia score improved from 4.66 to 2.54 (P < 0.001). All patients with tracheo-esophageal fistula had their symptoms successfully palliated. The immediate complication rate was 14% (n= 5); two patients had stent malpositioning, two had inadequate opening of their stents, and one had a failed stenting procedure. On follow-up, 15 (42.8%) patients required a total of 22 re-intervention procedures for various reasons: endoscopic dilatation (five dilatations in three patients), removal of foreign bodies (nine procedures in four patients), and insertion of a second SEMS related to tumor growth (eight stents in eight patients). There was no procedure-related mortality. The median survival was short at 42 days (range 5-290 days), mostly related to advanced disease stage. SEMS in patients with recurrent tumor after esophagogastrectomy is safe and effective.
尽管在没有先前手术的患者中广泛使用自膨式金属支架（SEMS），但先前接受过食管胃切除术的患者因肿瘤复发而出现症状，使用 SEMS 缓解症状的疗效尚未得到适当评估。本研究旨在评估先前接受过食管胃切除术的患者使用 SEMS 的疗效和安全性。研究组包括 35 例经证实因食管胃切除术局部复发而患有食管癌或贲门癌的患者，这些患者因缓解症状而放置了 SEMS。中位年龄为 67 岁（范围 41-85 岁）。支架置入的指征是吻合口复发（n=4）和食管残端复发（n=5）引起的吞咽困难、纵隔淋巴结疾病引起的外压性狭窄（n=7）；外压性肿瘤压迫引起的胃出口梗阻（n=13）；和气管食管瘘（n=6）。共进行了 43 次支架置入术，技术成功率为 97.6%。吞咽困难评分从 4.66 分改善至 2.54 分（P < 0.001）。所有气管食管瘘患者的症状均得到成功缓解。即刻并发症发生率为 14%（n=5）；2 例支架位置不当，2 例支架开放不足，1 例支架置入失败。随访时，15 例（42.8%）患者因各种原因共需要 22 次再干预：内镜扩张（3 例患者 5 次扩张）、取异物（4 例患者 9 次）、因肿瘤生长而置入第二个 SEMS（8 例患者 8 个支架）。无与操作相关的死亡。中位生存期较短，为 42 天（5-290 天），主要与晚期疾病有关。SEMS 治疗食管胃切除术后复发肿瘤是安全有效的。
