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目的 评价食管良、恶性狭窄球囊扩张和内支架置入的远期疗效及并发症。方法 15 6例食管良、恶性狭窄 ,行球囊扩张及置入内支架治疗 ,其中 12例良性狭窄行单纯球囊扩张 ,1例化学灼伤后食管自发性破裂并发纵隔脓肿及脓胸 ,采用可回收式记忆合金覆膜网状支架 ;14 3例恶性狭窄中 ,134例置入了金属内支架 ,9例作了球囊扩张。门诊食管造影或纤维内窥镜检查随访。结果 食管恶性狭窄随访 1～ 48个月 ,6 1例死亡 ,术后生存时间 1～ 33个月 ,平均 8.9个月。支架放置后再次出现吞咽困难 6 3例( 4 7% ) ,因食物及粘液在支架内嵌塞 3例 ,支架两端和支架腔内不规则狭窄 33例 ,狭窄仅局限于支架上端 19例 ,狭窄位于支架两端8例。纤维内窥镜检查发现 ,肿瘤组织 (或肉芽组织 )通过支架“网眼”向腔内和 (或 )两端生长。再次发生吞咽困难的 6 3例 ,均做了球囊扩张或再次内支架置入等治疗。食管良性狭窄随访 5～ 6 1个月 ,仍能进普食。结论 内支架置入术是姑息性治疗食管恶性狭窄的有效方法 ,肿瘤组织和增生的肉芽组织是引起再次狭窄的主要原因 ,带膜支架可有效降低再狭窄率 ,但不能阻止两端的狭窄 ;球囊扩张无效的良性狭窄 ,可放置回收式覆膜支架。
Objective To evaluate the long-term efficacy and complications of benign and malignant esophageal stricture balloon dilation and stent placement. [Methods] Sixteen patients with benign and malignant esophageal stenosis underwent balloon dilatation and stent placement. Among them, 12 cases of benign stricture were treated with simple balloon dilatation. One case of spontaneous rupture of esophagus after chemical burns was complicated by mediastinal abscess and empyema. Recycled memory alloy covered mesh scaffolds. Of the 143 malignant stenoses, 134 received metallic stent and 9 had balloon dilatation. Out-patient esophagectomy or fibro-endoscopy follow-up. Results Malignant esophageal strictures were followed up for 1 to 48 months, 61 died and the survival time was 1 to 33 months (mean, 8.9 months). There were again 63 cases of dysphagia after stent placement (47%). Three cases were implanted with food and mucus in the stent, 33 cases with irregular stenosis at both ends of the stent and the stent. The stenosis was only limited to the upper end of the stent in 19 cases, Stenosis at both ends of the stent in 8 cases. Fibrous endoscopy revealed that tumor tissue (or granulation tissue) grew into the lumen and / or both ends through the “mesh” of the scaffold. 63 cases of dysphagia occurred again, were done balloon dilatation or re-stenting and other treatment. Esophageal stricture followed up for 5 to 6 1 months, can still enter the general diet. Conclusion Stent implantation is an effective method for palliative treatment of malignant esophageal stenosis. Tumor tissue and proliferative granulation tissue are the main causes of restenosis. Stent graft can effectively reduce the rate of restenosis, but can not prevent the stenosis at both ends. The ball Expansion of ineffective benign balloon stenosis, can be placed on the stent graft.