Hills K S, Chopra K B, Pal A, Westaby D
Department of Gastroenterology, Chelsea and Westminster Hospital, London, UK.
Eur J Gastroenterol Hepatol. 1998 May;10(5):371-4. doi: 10.1097/00042737-199805000-00003.
Oesophageal self-expanding metal endoprostheses (SEMS, or stents) are recognized as a safe means of palliating dysphagia caused by malignancy. Stent designs that have covered or uncovered walls are now available. The purpose of this study was to compare the outcome of use of these two designs.
Thirty consecutive cases were reviewed. All the patients had been referred over a period of 25 months for palliation of dysphagia caused by malignant obstruction. Either a covered or an uncovered stent was placed in each patient. Palliation of dysphagia, 30 day mortality, mean survival time, and the number of endoscopic re-interventions required, were assessed.
Uncovered Ultraflex stents were used in 14 patients, and Schneider Wallstents were used in 16 patients. Dysphagia improved by one grade or more in 69% of patients. The 30 day mortality was 27%, with an overall mean survival time of 99 days. There was no significant difference between the two groups for these three parameters. Ten patients needed a total of 28 repeat endoscopic procedures to maintain stent patency, with overall rates for each group of 1.64 procedures per patient, for uncovered stents, compared with 0.31 for covered stents (significant at the P < 0.05 level). The number of repeat procedures increased with survival time.
The use of covered self-expanding metal oesophageal endoprostheses is associated with a significant reduction in the need for endoscopic reintervention after stent placement.
食管自膨式金属内支架（SEMS，或支架）被认为是缓解恶性肿瘤所致吞咽困难的一种安全方法。现在有带覆膜和不带覆膜的支架设计。本研究的目的是比较这两种设计的使用效果。
回顾了连续30例病例。所有患者在25个月的时间里因恶性梗阻所致吞咽困难而被转诊。为每位患者置入带覆膜或不带覆膜的支架。评估吞咽困难的缓解情况、30天死亡率、平均生存时间以及所需内镜再干预的次数。
14例患者使用了不带覆膜的Ultraflex支架，16例患者使用了施奈德Wallstent支架。69%的患者吞咽困难改善一级或更多。30天死亡率为27%，总体平均生存时间为99天。这三个参数在两组之间没有显著差异。10例患者共需要28次重复内镜检查以维持支架通畅，不带覆膜支架组每位患者的总体检查率为1.64次，而带覆膜支架组为0.31次（P<0.05水平有显著差异）。重复检查的次数随生存时间增加。
使用带覆膜的自膨式金属食管内支架与支架置入后内镜再干预需求的显著减少相关。
