Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
Endoscopy. 2011 Feb;43(2):156-9. doi: 10.1055/s-0030-1255849. Epub 2010 Dec 16.
Benign esophageal perforations and anastomotic leaks can be effectively managed by stent placement. However, when partially covered self-expanding metal stents (SEMS) are used, safe removal may be complicated. In this case series, we evaluated the complicated removal of SEMS placed for a benign esophageal perforation or leak in four patients. In all patients a partially covered SEMS was placed. After a median stent time of 29 days (range 21 - 30), the SEMS were found to have become embedded in the esophageal wall. Endoscopic removal resulted in perforation in all patients. All patients recovered uneventfully, although one patient underwent esophagectomy. If uncovered SEMS ends become embedded, removal of the stent may cause major damage to the esophageal wall. It is therefore recommended to remove embedded partially covered SEMS only after first placing a fully covered SEMS or self-expanding plastic stent inside this stent to necrotize the ingrown tissue at the uncovered stent ends.
良性食管穿孔和吻合口瘘可以通过支架置入得到有效治疗。然而，当使用部分覆盖自膨式金属支架（SEMS）时，安全取出可能会变得复杂。在本病例系列中，我们评估了 4 名良性食管穿孔或瘘患者中放置 SEMS 后的复杂取出情况。所有患者均放置部分覆盖 SEMS。在中位支架时间 29 天（范围 21-30 天）后，发现 SEMS 已嵌入食管壁。所有患者的内镜下取出均导致穿孔。所有患者均顺利恢复，尽管有 1 例患者行食管切除术。如果未覆盖的 SEMS 末端嵌入，则取出支架可能会对食管壁造成严重损伤。因此，建议仅在首次放置全覆膜 SEMS 或自膨式塑料支架于该支架内以使未覆盖的支架末端的植入组织坏死之后，再取出嵌入的部分覆盖 SEMS。
