Department of Upper GI Surgery, Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, Cheshire, UK.
J Surg Oncol. 2012 Jan;105(1):60-5. doi: 10.1002/jso.22059.
Self-expanding metal stents (SEMS) are an accepted intervention for malignant dysphagia. Stents vary in ease of insertion, removability, migration and occlusion rates. This series reports the complications, morbidity and mortality associated with several SEMS.
A prospective database of patients undergoing fluoroscopic guided oesophageal stent insertion for malignancy between June 2001 and June 2009 was analysed. Patient demographics, intervention outcomes and tumour variables were correlated with stent failure and patient survival. Multivariate analysis was performed to evaluate predictors for stent failure.
Two hundred and seventy-three stents were deployed using nine different types of SEMS. The median Mellow-Pinkas dysphagia score significantly improved from 3 to 1 post-stent insertion (P < 0.001), with a technical success rate of 98%. Stent complications occurred in 95 (36%) patients [recurrent dysphagia n = 49 (19%), migration n = 24 and occlusion n = 25]. Multivariate analysis demonstrates that the covered Niti S stent fails significantly more than the double-layered Niti S stent (OR = 4, P < 0.005).
Oesophageal stent insertion provides good palliation for malignant dysphagia, however recurrent dysphagia remains a problem. This major complication occurs more frequently with covered Niti S stents than double-layered Niti S stents. This finding may aid the stent choice used in advanced oesophageal malignancy.
自膨式金属支架（SEMS）是治疗恶性吞咽困难的一种公认的介入方法。支架在插入、可移除性、迁移和闭塞率方面存在差异。本系列报告了几种 SEMS 相关的并发症、发病率和死亡率。
分析了 2001 年 6 月至 2009 年 6 月间接受荧光引导食管支架置入术治疗恶性肿瘤的患者的前瞻性数据库。患者的人口统计学、干预结果和肿瘤变量与支架失败和患者生存相关。进行多变量分析以评估支架失败的预测因素。
使用 9 种不同类型的 SEMS 共放置了 273 个支架。Mellow-Pinkas 吞咽困难评分中位数从支架置入前的 3 分显著改善至 1 分（P<0.001），技术成功率为 98%。95 名（36%）患者出现支架并发症[复发性吞咽困难 49 例（19%）、迁移 24 例和闭塞 25 例]。多变量分析表明，覆盖型 Niti S 支架的失败率明显高于双层 Niti S 支架（OR=4，P<0.005）。
食管支架置入为恶性吞咽困难提供了良好的姑息治疗，但复发性吞咽困难仍然是一个问题。这种主要并发症在覆盖型 Niti S 支架中比双层 Niti S 支架更为常见。这一发现可能有助于选择在晚期食管恶性肿瘤中使用的支架。
