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目的评价非自扩支架及自扩金属支架治疗难治性食管良性狭窄的疗效及其优缺点。方法按应用食管支架类型的不同,分成非自扩支架组(23例)、自扩金属支架(SEMS)组(16例),从技术成功率、吞咽功能改善情况、支架的脱落情况、并发症发生率等方面进行临床对照研究。结果全组随访4～60个月,中位数12个月。全组吞咽功能状态:支架置入术前15、21、3例分别为2、3、4级,支架置入术后27、12例分别为0、1级,吞咽功能明显改善(z=-5.531,P=0.000),取得满意的近期效果。非自扩支架及SEMS均可明显改善患者的进食状态。两组的技术成功率均为100%;置支架术后吞咽功能状态两组差异无显著性意义(P=0.107)。非自扩支架组、SEMS组初次置入支架脱落的发生率分别为82.6%(19/23)、6.3%(1/16),差异有显著性意义(P=0.000),再狭窄发生率分别为34.6%、31.3%,差异无显著性意义(P=1.000),但再狭窄的原因不同。结论对于难治性食管良性狭窄,可采用支架治疗,选用非自扩支架在安全性及远期疗效上均优于SEMS。
Objective To evaluate the efficacy and advantages and disadvantages of non-self-expanding stents and self-expanding metal stents in the treatment of refractory esophageal strictures. Methods According to the types of esophageal stents, the patients were divided into non-self-expanding stent group (23 cases) and self-expanding metal stent group (16 cases). The technical success rate, improvement of swallowing function, Incidence and other aspects of clinical control study. Results The whole group was followed up for 4 to 60 months with a median of 12 months. The swallowing functional status of the whole group was grade 2, 3, and 4 in 15 cases, 21 cases in 3 cases, and 0 grade 1 in 27 cases after stenting. The swallowing function was significantly improved (z = 5.531, P = 0.000), to obtain satisfactory near-term effect. Non-self-expanding stent and SEMS can significantly improve the patient’s eating status. The technical success rates of both groups were 100%. There was no significant difference between the two groups in the postoperative swallowing function (P = 0.107). The incidence of stent ablation in the SEMS group was 82.6% (19/23) and 6.3% (1/16) respectively, with significant difference (P = 0.000) and restenosis rates (34.6%, 31.3%), the difference was not statistically significant (P = 1.000), but the reasons for restenosis were different. Conclusion For the treatment of benign esophageal stenosis, stent treatment can be used, the selection of non-self-expanding stent in the safety and long-term efficacy are better than the SEMS.