De Palma G D, di Matteo E, Romano G, Fimmano A, Rondinone G, Catanzano C
Servizio Centralizzato di Endoscopia Digestiva Operatoria, Università, Federico II di Napoli, Facoltà di Medicina e Chirurgia, Italy.
Gastrointest Endosc. 1996 May;43(5):478-82. doi: 10.1016/s0016-5107(96)70290-0.
Rapid palliation of malignant dysphagia is usually possible with endoscopic implantation of a plastic prosthesis, but this device has a high rate of complications. Recently, expandable metal stents, a new class of endoprosthesis, have become available and may reduce complication rates.
Thirty nine patients affected by esophageal thoracic cancer were randomly assigned to treatment with either a plastic stent (20 patients) or expandable metal stent (19 patients). The degree of palliation (expressed as dysphagia score) and incidence of complications (short- and long-term) were compared in both treatment groups.
Technical success, as a percentage of successful intubation, was similar in both treatment groups (90% vs 94.7%, p = NS) and dysphagia scores improved significantly and similarly in both treatment groups. Nevertheless, complications and mortality related to implantation were significantly less frequent with metal stents than with plastic prostheses (complications: 0% vs 21%, p < 0.001; mortality: 0% vs. 15.8%, p < 0.001). Late complications included obstruction by food in both treatment groups (four cases with plastic stents vs four cases with metal stents), tube migration only with plastic prostheses (two cases) and tumor ingrowth only with metal stents (two cases).
Expandable metal stents can be considered an effective and safer alternative to conventional plastic prostheses in the treatment of esophageal obstruction caused by inoperable cancer.
通过内镜植入塑料假体通常可以迅速缓解恶性吞咽困难，但这种装置并发症发生率很高。最近，一种新型的内置假体——可扩张金属支架已经问世，可能会降低并发症发生率。
39例胸段食管癌患者被随机分为两组，分别接受塑料支架治疗（20例）或可扩张金属支架治疗（19例）。比较两组的缓解程度（以吞咽困难评分表示）和并发症发生率（短期和长期）。
两组的技术成功率（以成功插管的百分比表示）相似（90%对94.7%，p = 无显著性差异），且两组的吞咽困难评分均有显著且相似的改善。然而，与植入相关的并发症和死亡率，金属支架组明显低于塑料假体组（并发症：0%对21%，p < 0.001；死亡率：0%对15.8%，p < 0.001）。晚期并发症包括两组均有食物阻塞（塑料支架组4例，金属支架组4例），仅塑料假体有管道移位（2例），仅金属支架有肿瘤长入（2例）。
在治疗无法手术切除的癌症所致食管梗阻方面，可扩张金属支架可被视为传统塑料假体的一种有效且更安全的替代方案。
