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内镜下从食管中移除自膨式金属支架

发布日期:2014-1-29 12:40:12 文章来源:GIE(July,2011) 作者次数:1139
    背景
    自膨式金属支架(SEMSs)的应用越来越广,它作为一种临时设备,为食管恶性病变或良性食管缺损、狭窄患者的放化疗创造条件。
    目的
    评估从大批患有良性或恶性食管疾病患者体内移除自膨式金属支架(SEMSs)后的结果。
    设计
    观察研究,规范化治疗与术后随访。
    单一大学中心(Single university center)
    患者
    纳入2001年至2010年期间进行內镜下自膨式金属支架(SEMS)移除的95例患者
    內镜支架移除
    主要评价指标
    技术、功能结果和并发症。
    结果
    对95例患者进行124枚支架移除,所有部分覆膜(68%)和全覆(32%)自膨式金属支架(SEMSs)都被移除。3例患者中有2处自膨式金属支架(SEMSs)重叠。一次性成功移除率达到89%,二次性成功移除率为96%。全覆膜支架未发生并发症的一次性移除比例明显高于部分覆膜支架(P =0.035),单一支架未发生并发症的一次性移除比例也显著高于重叠支架(P =0.033) 。一次性移除支架时发生并发症者与未发生并发症者相比,支架置入时间较长,分别为126 天,28 天,且P =0.01。3例患者(2.4%)需进行外科手术移除支架,6例患者(5%)发生中重度与內镜移除相关的并发症。
    局限性
    回顾性,非随机研究设计。
    结论
    对于大多数有良性和恶性食管病变患者来说,自膨式金属支架一次性內镜移除是可行的。支架置入时间延长和使用部分覆膜SEMSs,这二者都会阻碍移除顺利进行。而且由于可能会发生支架解体和随后并发症,所以对仅需临时使用者,应该避免自膨式金属支架(SEMSs)重叠置入。
     

    缩写::IQR为内距,SEMS为自膨式金属支架。

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    Endoscopic removal of self-expandable metal stents from the esophagus

    Abstract
     
    Background
    Self-expandable metals stents (SEMSs) have increasingly been used as a temporary device to bridge chemoradiotherapy in patients with malignant esophageal disease or in patients with benign esophageal defects or stenosis.
    Objective
    To evaluate the outcome of removal of SEMSs in a large cohort of patients with benign and malignant esophageal disease.
    Design
    Observational study with standardized treatment and follow-up.
    Setting
    Single university center.
    Patients
    Between 2001 and 2010, 95 consecutive patients referred for endoscopic SEMS extraction were included.
    Interventions
    Endoscopic stent removal.
    Main Outcome Measurements
    Technical and functional outcome and complications.
    Results
    A total of 124 stent extractions were undertaken in 95 patients; both partially covered (68%) and fully covered (32%) SEMSs were removed. Three patients had 2 overlapping SEMSs in place. Successful primary removal was achieved in 89%; the secondary removal rate was 96%. Uncomplicated primary removal rate was significantly higher for fully covered versus partially covered stents (P = .035) and for single versus overlapping stents (P = .033). Patients with a complicated stent removal had the stent in place significantly longer compared with patients with an uncomplicated primary stent removal (126 days vs 28 days; P = .01). Surgical removal was required in 3 patients (2.4%). Six moderate and severe complications (5%) related to the endoscopic extraction occurred.
    Limitations
    Retrospective, nonrandomized study design.
    Conclusions
    Primary endoscopic removal of an SEMS is feasible in the majority of patients with benign and malignant esophageal disease. A longer time that a stent is in place and the use of partially covered SEMSs both impede removal. Moreover, overlapping SEMSs should be avoided for temporary use because stent disintegration and subsequent complications may occur.
     
    (作者:)
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