Bjerring Ole Steen, Pless Torsten, Fristrup Claus, Mortensen Michael Bau
Aarestrupvej 25, 5230 Odense M, Denmark.
Dan Med J. 2012 Jun;59(6):A4459.
Dysphagia is the most common symptom of malignant obstruction in the oesophagus and at the gastro-oesophageal junction (GEJ) region, and the relief of dysphagia plays a major role in palliative treatment of this condition. The aim of the present study was to evaluate the need for and nature of re-intervention after self-expanding metallic stents (SEMS) insertion in patients who were palliated for cancer of the oesophagus or GEJ.
At a third-level referral centre in Denmark, all SEMS procedures were prospectively registered for SEMS characteristics and procedural events and data regarding re-interventions and survival were retrieved retrospectively in a six-year inclusion period.
A total of 108 stents were inserted into 87 patients (63 males and 23 females) with a median age of 71 years (range: 41-94 years). The primary SEMS used was Ultraflex in 77, Cook or Choo in seven and Wallstent in three cases. All but one SEMS were successfully placed, and no perforations occurred. Fifty patients had their dysphagia scores recorded. The average score before and after stent insertion was 2.4 and 0.8, respectively, (p < 0.01). Two-thirds of the patients needed late re-interventions. The most common problem was tissue/tumour ingrowth (n = 40). Seven patients (8%) experienced stent migration. The average re-intervention rate was 2.8 per patient. The median survival after SEMS was 116 days (range 2-866 days). The median time to first re-intervention was 44 days.
SEMS treatment was a safe and effective palliation of malignant obstruction in the oesophagus and GEJ region, but the procedure was associated with a frequent need for re-interventions.
吞咽困难是食管及胃食管交界（GEJ）区域恶性梗阻最常见的症状，缓解吞咽困难在该疾病的姑息治疗中起主要作用。本研究的目的是评估食管或GEJ癌姑息治疗患者置入自膨式金属支架（SEMS）后再次干预的必要性及性质。
在丹麦的一家三级转诊中心，前瞻性记录所有SEMS手术的SEMS特征和手术事件，并回顾性检索六年纳入期内有关再次干预和生存的数据。
共对87例患者（63例男性和23例女性）置入了108枚支架，中位年龄为71岁（范围：41 - 94岁）。使用的主要SEMS为Ultraflex，共置入77枚；Cook或Choo置入7枚；Wallstent置入3枚。除1枚SEMS外，其余均成功置入，未发生穿孔。记录了50例患者的吞咽困难评分。支架置入前后的平均评分分别为2.4和0.8（p < 0.01）。三分之二的患者需要后期再次干预。最常见的问题是组织/肿瘤向内生长（n = 40）。7例患者（8%）发生支架移位。每位患者的平均再次干预率为2.8次。SEMS置入后的中位生存期为116天（范围2 - 866天）。首次再次干预的中位时间为44天。
SEMS治疗是食管及GEJ区域恶性梗阻安全有效的姑息治疗方法，但该手术常需要再次干预。
