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一个新的全覆膜金属支架治疗良性与恶性吞咽困难:一项前瞻性随访研究

发布日期:2014-1-29 12:40:41 文章来源:GIE 作者次数:1464

     一个新的全覆膜金属支架治疗良性与恶性吞咽困难:一项前瞻性随访研究

    背景

    越来越多的全覆膜自膨式金属支架(FCSEMSs)用于治疗恶性和良性狭窄。尤其在治疗良性狭窄时,众所周知,FCSEMSs转移率较高。因此,我们开发了一个新型可降低转移率的狗骨状且内覆膜的FCSEMS

    目的

    评估复发性吞咽困难与新型全覆膜支架治疗良性和恶性食管疾病的安全性。

    设计

    本研究为一项前瞻性随访研究。

    环境

    三级转诊中心。

    患者

    2009年至20112月,48例患者(平均年龄为61岁,范围为28-81岁)接受了全覆膜支架植入以治疗恶性(n = 33)或良性(n = 15)吞咽困难。

    干预

    全覆膜支架植入。

    主要测量结果

    复发性吞咽困难和并发症。

    结果

    全覆膜支架植入适应症包括食管癌(n = 28)、外在恶性压迫症(n = 4)、食管癌切除术后复发恶性肿瘤(n = 1)、难治性食管良性狭窄(n = 15)。在恶性狭窄患者中,5例(15%)患者由于支架移位(n=3),组织增生(n=1)和急性水肿(n=1而出现复发性吞咽困难。在良性狭窄患者中,9例(60%)患者由于支架移位(n=5),组织增生(n=3)和疼痛(n=1)而被过早地移除支架。支架移除后,所有患者均出现复发性吞咽困难。10例(30%)恶性狭窄和3例(20%)良性狭窄患者出现主要并发症,这些主要并发症包括剧烈疼痛和/或呕吐(n=8)、瘘管形成(n=2)、出血(n=2)和吸入性肺炎(n=1)。

    局限性

    非随机话研究设计。

    结论

    尽管新型全覆膜支架可有效治疗恶性吞咽困难,但它可产生许多主要并发症。将新型全覆膜支架移除后,难治性食管良性狭窄患者很快表现出复发性吞咽困难。

    缩写词:CRT,化学疗法和/或放射疗法;FC,全覆膜;FCSEMS,全覆膜自膨式金属支架;PC,部分覆膜;RBES难治性食管良性狭窄;SEMS,自膨式金属支架;SEPS,自膨式塑料支架。

     


    A new fully covered metal stent for the treatment of benign and malignant dysphagia: a prospective follow-up study

    Background

    Fully covered self-expandable metal stents (FCSEMSs) are increasingly being used for malignant and benign strictures. Particularly in the latter, FCSEMSs are known for their high migration rates. A new FCSEMS with a dog-bone shape and internal covering was developed to reduce migration risk.

    Objective

    To evaluate recurrent dysphagia, and safety of the new FC stent in benign and malignant esophageal disorders.

    Design

    Prospective follow-up study.

    Setting

    Tertiary referral center.

    Patients

    Between November 2009 and February 2011, 48 consecutive patients (mean age 61 years, range 28-81 years) underwent FC stent placement for malignant (n = 33) or benign (n = 15) dysphagia.

    Intervention

    FC stent placement.

    Main Outcome Measurements

    Recurrent dysphagia and complications.

    Results

    Indications for FC stent placement included esophageal cancer (n = 28), extrinsic malignant compression (n = 4), recurrent malignancy after esophagectomy (n = 1), and refractory benign esophageal stricture (n = 15). In malignant strictures, recurrent dysphagia occurred in 5 patients (15%) because of stent migration (n = 3), tissue overgrowth (n = 1), and acute edema (n = 1). In benign strictures, stents were prematurely removed in 9 (60%) patients because of stent migration (n = 5), tissue overgrowth (n = 3), and pain (n = 1). Recurrent dysphagia occurred in all patients after stent removal. Major complications occurred in 10 patients (30%) with malignant strictures and in 3 patients (20%) with benign strictures and included severe pain and/or vomiting (n = 8), fistula formation (n = 2), bleeding (n = 2), and aspiration pneumonia (n = 1).

    Limitation

    Nonrandomized study design.

    Conclusion

    Although the new FC stent effectively treats malignant dysphagia, it is associated with substantial major complications. In patients with refractory benign esophageal strictures, recurrent dysphagia occurs rapidly after removal of the new FC stent.

    Abbreviations:  CRT, chemotherapy and/or radiotherapy, FC, fully covered, FCSEMS, fully covered self-expandable metal stent, PC, partially covered, RBES, refractory benign esophageal stricture, SEMS, self-expandable metal stent, SEPS, self-expandable plastic stent

     

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