Binmoeller K F, Krug C, Rehner M, Seifert H, Soehendra N
Abteilung für Endoskopische Chirurgie, Chirurgische Universitätsklinik Hamburg-Eppendorf.
Zentralbl Chir. 1997;122(1):44-8.
Endoscopic placement of an esophageal prosthesis is a well established palliative treatment for esophageal carcinoma. However, the treatment of high cervical tumors using commercially available plastic prostheses is problematic. We modified the design and implantation techniques of the Celestin prosthesis to accommodate high cervical tumors and report our results in 38 patients. Over a 7 year period 42 modified Celestin prostheses were implanted in 38 patients with high cervical esophageal tumors. 15 had stenosis only, 22 had a stenosis and fistula, and one had a fistula without stenosis. Graduated bouginage up to 38 Fr or 42 Fr for large prostheses was performed prior to stent placement in an average of 2.3 sessions. There were no procedure-related complications. Only in one case the prosthesis had to be withdrawn after reimplantation because of intolerable painful foreign body sensation. Improvement of dysphagia was achieved in 34 patients. The fistulas could be adequately bridged and sealed in 17 of 23 patients. Prostheses migrated in 11 cases (proximally, n = 6; distally, n = 5). Mean patient survival in 28 patients followed until death was 86 days (range 5-338 days).
内镜下放置食管假体是一种成熟的食管癌姑息治疗方法。然而，使用市售塑料假体治疗高位颈段肿瘤存在问题。我们对Celestin假体的设计和植入技术进行了改进，以适应高位颈段肿瘤，并报告了我们对38例患者的治疗结果。在7年的时间里，为38例高位颈段食管肿瘤患者植入了42个改良的Celestin假体。15例仅有狭窄，22例有狭窄和瘘管，1例有瘘管无狭窄。在放置支架前，平均进行2.3次扩张，最大扩张至38F或42F（用于大型假体）。没有与操作相关的并发症。只有1例患者在重新植入后因难以忍受的疼痛性异物感而不得不取出假体。34例患者吞咽困难得到改善。23例患者中有17例的瘘管得到了充分的桥接和封闭。11例假体发生移位（近端6例，远端5例）。28例患者随访至死亡，平均生存时间为86天（范围5 - 338天）。
