Ellul J P, Watkinson A, Khan R J, Adam A, Mason R C
Department of Surgery, Guy's Hospital, London, UK.
Br J Surg. 1995 Dec;82(12):1678-81. doi: 10.1002/bjs.1800821231.
Adequate palliation of dysphagia due to inoperable oesophageal carcinoma is difficult to achieve with low morbidity. Thirty-three patients (21 men and 12 women of mean(s.e.m.) age 69(2) years) with inoperable carcinoma of the oesophagus underwent insertion of self-expanding metal stents. In 22 patients the tumours were in the lower third of the oesophagus, in eight in the middle third and in three in the upper third. A stent was inserted as primary palliative therapy in 14 patients, after failed laser therapy in 13 and after oesophageal perforation following other treatments in six. Patients presented with dysphagia of grade 3 or 4. Three types of stent were used: Wallstent, Strecker and Gianturco; stents were inserted under fluoroscopic guidance after balloon dilatation of the stricture. All attempted insertions of metal stents were successful. Dysphagia reduced from grade 3 or 4 to 0 or 1. There were no perforations related to insertion. Patients who had stents inserted to seal previous perforations left hospital a median 7 days later. Dysphagia recurred in six patients, due to migration of the stent (three), blockage by food bolus (one) and tumour overgrowth (two). These problems were easily treated. Self-expanding metal stents seem to offer excellent palliation with minimal morbidity for patients with inoperable carcinoma of the oesophagus.
对于无法手术的食管癌患者，要在低并发症发生率的情况下充分缓解吞咽困难是很难实现的。33例无法手术的食管癌患者（21例男性，12例女性，平均（标准误）年龄69（2）岁）接受了自膨式金属支架置入术。22例患者的肿瘤位于食管下三分之一段，8例位于中三分之一段，3例位于上三分之一段。14例患者将支架置入作为主要姑息治疗手段，13例在激光治疗失败后置入，6例在其他治疗后发生食管穿孔后置入。患者均表现为3级或4级吞咽困难。使用了三种类型的支架：Wallstent支架、Strecker支架和Gianturco支架；在对狭窄部位进行球囊扩张后，于荧光镜引导下置入支架。所有金属支架置入尝试均获成功。吞咽困难程度从3级或4级降至0级或1级。未发生与置入相关的穿孔。因先前穿孔而置入支架的患者中位住院时间为7天后出院。6例患者吞咽困难复发，原因分别为支架移位（3例）、食物团块阻塞（1例）和肿瘤过度生长（2例）。这些问题易于处理。自膨式金属支架似乎可为无法手术的食管癌患者提供极佳的姑息治疗效果，且并发症发生率极低。
