Kim Ji Yeon, Kim Sang Gyun, Lim Joo Hyun, Im Jong Pil, Kim Joo Sung, Jung Hyun Chae
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine.
Department of Intestinal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
J Dig Dis. 2015 Oct;16(10):575-84. doi: 10.1111/1751-2980.12280.
To evaluate the efficacy and feasibility of esophageal self-expanding metal stents (SEMS) insertion for malignant esophageal obstruction (MEO) in patients with or without additional palliative treatment.
We retrospectively reviewed the medical records of the patients with SEMS for MEO. Baseline characteristics, changes in Mellow-Pinkas dysphagia score, and adverse events were collected and compared according to the presence and absence of additional palliative treatment.
Altogether 192 patients underwent 236 SEMS insertion procedures. Esophageal, gastric cardiac and lung cancers were seen in 46.4%, 33.3% and 15.1% of the patients, respectively. Their Mellow-Pinkas score significantly decreased within one week and one month after the SEMS insertion (1.66 ± 0.79 and 1.71 ± 0.87 vs 3.09 ± 0.79, respectively, P = 0.000). Complications occurred in 54 (22.9%) of 236 SEMS insertion; there were 28 (11.9%) stent obstruction, 5 (2.1%) perforation (2.1%), 10 (4.2%) stent migration, 5 (2.1%) tracheoesophageal fistula, but no procedure-related death. Most complications were managed by inserting additional SEMS. The risk of stent obstruction was significantly higher in uncovered stents than in covered SEMS (OR 3.56, 95% CI 1.39-9.12, P = 0.006). Mean duration to the development of complications was 74.8 ± 111.1 days. Overall survival (169.0 ± 127.8 days vs 96.4 ± 90.6 days, P = 0.000) and stent patency (143.3 ± 123.9 days vs 67.6 ± 71.3 days, P = 0.000) were significantly favorable in patients with SEMS and additional palliative treatments compared with those with SEMS alone.
SEMS insertion is effective and safe for treating MEO, and additional palliative treatment might lengthen stent patency by prolonging the patient's survival.
评估食管自膨式金属支架（SEMS）置入术治疗伴有或不伴有其他姑息治疗的恶性食管梗阻（MEO）患者的疗效和可行性。
我们回顾性分析了接受SEMS治疗MEO患者的病历。根据是否接受其他姑息治疗，收集并比较患者的基线特征、Mellow-Pinkas吞咽困难评分变化及不良事件。
共192例患者接受了236次SEMS置入术。食管癌、贲门癌和肺癌患者分别占46.4%、33.3%和15.1%。SEMS置入术后1周和1个月时，患者的Mellow-Pinkas评分显著降低（分别为1.66±0.79和1.71±0.87，而术前为3.09±0.79，P = 0.000）。236次SEMS置入术中，54例（22.9%）发生并发症；支架梗阻28例（11.9%），穿孔5例（2.1%），支架移位10例（4.2%），气管食管瘘5例（2.1%），无手术相关死亡。大多数并发症通过再次置入SEMS处理。裸支架梗阻风险显著高于覆膜SEMS（比值比3.56，95%置信区间1.39 - 9.12，P = 0.006）。并发症发生的平均时间为74.8±111.1天。与单纯接受SEMS治疗的患者相比，接受SEMS联合其他姑息治疗的患者总生存期（169.0±127.8天 vs 96.4±90.6天，P = 0.000）和支架通畅时间（143.3±123.9天 vs 67.6±71.3天，P = 0.000）明显更长。
SEMS置入术治疗MEO有效且安全，联合其他姑息治疗可能通过延长患者生存期来延长支架通畅时间。
