Markos Pave, Sisko Markos Ines, Ivekovic Hrvoje, Bilic Branko, Rustemovic Nadan
Endoscopy Unit, Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Croatia.
Department of Oncology and Nuclear Medicine, University Hospital Sisters of Mercy, Zagreb, Croatia.
Arab J Gastroenterol. 2019 Mar;20(1):28-31. doi: 10.1016/j.ajg.2019.01.004. Epub 2019 Feb 4.
We intended to evaluate the role of self-expandable metal stents (SEMS) for palliation of malignant dysphagia in patients with lung cancer.
During the period between May 2015 and September 2017, 42 SEMS have been placed for malignant dysphagia in patients with lung cancer. Stents have been placed under combined fluoroscopic and endoscopic guidance.
Data from 42 patient were analysed. 35 patients (83%) were males and the mean age was 68,4 years (range 52-80 y). In 26 patients (61%) cause of dysphagia was extraluminal mediastinal lymphadenopathy and in others direct tumour infiltration of the oesophagus. A tracheo-oesophageal fistula (TEF) was seen in 8 patients (19%). Most of the patients (32 patients; 76%) had stage 3 dysphagia (able to swallow liquids only) and the rest (10 patients; 24%) stage 4 (unable to swallow saliva). Thirty stents (71%) were partially covered and 12 (29%) were fully covered. Five (12%) stents have been placed across the oesophagogastric junction due to infiltration of the cardia. There were no immediate complications except for aspiration pneumonia in 3 (7%) and minor bleeding in 2 (5%) patients which resolved spontaneously. Dysphagia score improved in all patients to stage 1 (dysphagia with certain solid food in 16 patients-38%) or stage 2 (able to swallow semi solid in 26 patients-62%). In 3 (7%) patients during the follow-up we encountered tumour overgrowth and in 1 patients the TEF was not sealed so they have been referred for gastrostomy. No other long term complications were recorded. Most of the patients (30 patients- 71%) died during the follow-up, with mean survival of 4 months (range 2-9) after the stent placement.
Placing SEMS in patients with lung cancer is safe and highly effective in relieving dysphagia with significant improvement in quality of life.
我们旨在评估自膨式金属支架（SEMS）在缓解肺癌患者恶性吞咽困难方面的作用。
在2015年5月至2017年9月期间，为42例肺癌合并恶性吞咽困难的患者置入了SEMS。支架在荧光镜和内镜联合引导下置入。
分析了42例患者的数据。35例（83%）为男性，平均年龄68.4岁（范围52 - 80岁）。26例（61%）患者吞咽困难的原因是纵隔外淋巴结肿大，其他患者为肿瘤直接侵犯食管。8例（19%）患者出现气管食管瘘（TEF）。大多数患者（32例；76%）为3期吞咽困难（仅能吞咽液体），其余（10例；24%）为4期（无法吞咽唾液）。30个支架（71%）为部分覆盖，12个（29%）为完全覆盖。5个（12%）支架因贲门浸润而置于食管胃交界处。除3例（7%）发生吸入性肺炎和2例（5%）发生少量出血且均自行缓解外，无即刻并发症。所有患者的吞咽困难评分均改善至1期（16例患者 - 38%能吞咽某些固体食物）或2期（26例患者 - 62%能吞咽半固体食物）。随访期间，3例（7%）患者出现肿瘤过度生长，1例患者的TEF未闭合，因此他们被转诊进行胃造瘘术。未记录到其他长期并发症。大多数患者（30例 - 71%）在随访期间死亡，支架置入后平均生存期为4个月（范围2 - 9个月）。
对肺癌患者置入SEMS安全且能高效缓解吞咽困难，显著改善生活质量。
