Baral J, Bähr R
Allgemein- und thoraxchirurgische Klinik, Städtisches Klinikum Karlsruhe GmbH.
Zentralbl Chir. 1998;123(10):1140-4.
A wide range of therapeutic methods for treatment of malignant and benign stenoses of the upper gastrointestinal tract is at one's disposal with esophageal mechanical dilatation, laser therapy, insertion of plastic tubes and stent implantation. It has become routine to insert flexible metal stents in the treatment of esophageal carcinoma and tracheoesophageal fistula. Case reports exist describing the use of flexible metal stents in complicated benign esophageal stenoses of stomach and duodenum. Until January 1997 we implanted 18 stents (7 Z-stents[Wilson and Cook], 4 covered and 4 uncovered Ultraflex stents [Boston Scientific], 3 Endocoil stents [Instent]) in 15 patients. We treated patients with esophageal carcinoma, recurrent stenoses after gastrectomy and tracheoesophageal fistula. They were followed by questionnaires. Four days after stent implantation 50% of the patients were able to consume normal solid food, the other half semisolids. The main problem was the stent migration (28%). The decisive factors for stent migration were the quality of surface of the stent and its position in the gastroesophageal junction. The stents which were dislocated in the stomach could easily be extracted endoscopically. The endoscopic extraction of a dislocated Z-stent in the small bowel was impossible. The high rate of stent dislocation (20-30%) in distal stent position (gastroesophageal junction) is not to be tolerated with respect to the purchase price.
上消化道恶性和良性狭窄的治疗有多种治疗方法可供选择，包括食管机械扩张、激光治疗、塑料管插入和支架植入。在食管癌和气管食管瘘的治疗中，插入柔性金属支架已成为常规操作。有病例报告描述了柔性金属支架在胃和十二指肠复杂良性食管狭窄中的应用。截至1997年1月，我们为15例患者植入了18个支架（7个Z形支架[威尔逊和库克公司]，4个覆膜和4个未覆膜的超柔性支架[波士顿科学公司]，3个Endocoil支架[英斯滕特公司]）。我们治疗了食管癌、胃切除术后复发性狭窄和气管食管瘘患者。对他们进行了问卷调查。支架植入后四天，50%的患者能够食用正常固体食物，另一半患者食用半固体食物。主要问题是支架移位（28%）。支架移位的决定性因素是支架表面质量及其在胃食管交界处的位置。移位到胃内的支架可以很容易地通过内镜取出。在小肠内移位的Z形支架无法通过内镜取出。就购买价格而言，远端支架位置（胃食管交界处）较高的支架移位率（20%-30%）是不能容忍的。
