全覆膜金属可回收支架在治疗食管顽固性良性狭窄中的应用价值
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摘要
目的探讨全覆膜金属可回收支架治疗食管顽固性良性狭窄的安全性及疗效。方法回顾性分析行全覆膜金属可回收支架治疗的33例食管顽固性良性狭窄患者的临床资料,评价治疗的可行性、安全性及疗效。结果 33例患者共计放置可回收支架41支,其中8例患者行二次可回收支架置入,术后均有不同程度胸痛及异物感;术后并发支架移位11例(共计14支),移位发生率34.1%(14/41);其余22例患者(共计27支支架)均于术后4~8周顺利回收。术中及术后无明显出血、穿孔等并发症发生,无支架相关死亡病例。所有患者定期参加随访(>12个月),其中12例成功解除梗阻,临床缓解率为36.4%(12/33)。结论全覆膜金属可回收支架用于治疗食管顽固性良性狭窄是安全可靠的,可使部分患者成功解除梗阻,但支架移位发生率高,有待于临床进一步研究解决。
Objective To assess the safety and effectiveness of removable,fully covered,self-expandable metal stents in patients with refractory benign esophageal strictures.Methods The date of 33 patients with refractory benign esophageal strictures treated with removable,fully covered,self-expandable metal stents were retrospected.Feasibility,safety and effects were evaluated accordingly.Results Thirty-three patients underwent esophageal stent placement for refractory benign esophageal strictures,with a total of 41 stents were placed.8 out of 33 patients underwent a second stent placement.All of the patients experienced different levels of chest pain and foreign body sensation after stent placement.Stents migration were observed in 11 patients(with a total of 14 stents),the migration rate was 34.1%(14/41).The other 22 patients with a total of 27 stents were removed within 4 ~ 8 weeks after placement.No obvious bleeding or esophageal rupture was found during stent placement or stent removal.None of patients died with stent placement.All of the patients were followed up regularly after stent removal(>12 months),12 out of 33 patients were free from dysphagia,the stricture resolution rate was 36.4%(12/33).Conclusion Use of removable,fully covered,self-expandable metal stents seem to be a safe and reliable method of treatment in patients with refractory benign esophageal strictures.It can make some patients were successfully free from dysphagia,but have a high incidence of stents migration,so the further research will be necessary to solve this problem.
Objective To assess the safety and effectiveness of removable,fully covered,self-expandable metal stents in patients with refractory benign esophageal strictures.Methods The date of 33 patients with refractory benign esophageal strictures treated with removable,fully covered,self-expandable metal stents were retrospected.Feasibility,safety and effects were evaluated accordingly.Results Thirty-three patients underwent esophageal stent placement for refractory benign esophageal strictures,with a total of 41 stents were placed.8 out of 33 patients underwent a second stent placement.All of the patients experienced different levels of chest pain and foreign body sensation after stent placement.Stents migration were observed in 11 patients(with a total of 14 stents),the migration rate was 34.1%(14/41).The other 22 patients with a total of 27 stents were removed within 4 ~ 8 weeks after placement.No obvious bleeding or esophageal rupture was found during stent placement or stent removal.None of patients died with stent placement.All of the patients were followed up regularly after stent removal(>12 months),12 out of 33 patients were free from dysphagia,the stricture resolution rate was 36.4%(12/33).Conclusion Use of removable,fully covered,self-expandable metal stents seem to be a safe and reliable method of treatment in patients with refractory benign esophageal strictures.It can make some patients were successfully free from dysphagia,but have a high incidence of stents migration,so the further research will be necessary to solve this problem.
引文
[1]LIU J,HU Y,CUI C,et al.Removable,fully covered,selfexpandable metal stents for the treatment of refractory benign esophagogastric anastomotic strictures[J].Dysphagia,2012,27(2):260-264.
[2]SHI Q,JU H,YAO L Q,et al.Risk factors for postoperative stricture after endoscopic submucosal dissection for superficial esophageal carcinoma[J].Endoscopy,2014,46(8):640-644.
[3]ONO S,FUJISHIRO M,NIIMI K,et al.Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms[J].Endoscopy,2009,41(8):661-665.
[4]鞠辉,钟芸诗,姚礼庆,等.早期食管癌内镜黏膜下剥离术后食管狭窄的危险因素分析[J].中华消化内镜杂志,2013,30(6):310-314.[4]JU H,ZHONG Y S,YAO L Q,et al.Risk factors of esophageal stricture after endoscopic submucosal dissection for early stage esophageal cancer[J].Chin J Dig Endosc,2013,30(6):310-314.Chinese
[5]ELOUBEIDI M A,TALREJA J P,LOPES T L,et al.Success and complications associated with placement of fully covered removable self-expandable metal stents for benign esophageal diseases(with videos)[J].Gastrointest Endosc,2011,73(4):673-681.
[6]SUZUKI T,SIDDIQUI A,TAYLOR L J,et al.Clinical outcomes,efficacy,and adverse events in patients undergoing esophageal stent placement for benign indications:a large multicenter study[J].J Clin Gastroenterol,2016,50(5):373-378.
[7]DAN D T,GANNAVARAPU B,LEE J G,et al.Removable esophageal stents have poor efficacy for the treatment of refractory benign esophageal strictures(RBES)[J].Diseases of the Esophagus,2014,27(6):511-517.
[8]CHAPUT U,HERESBACH D,AUDUREAU E,et al.Comparison of a standard fully covered stent with a super-thick siliconecovered stent for the treatment of refractory esophageal benign strictures:a prospective multicenter study[J].United European Gastroenterology Journal,2013,1(2):93-102.
[9]KIM H J,SONG H Y,CHOI E K,et al.Temporary metallic stent placement in the treatment of refractory benign esophageal strictures:results and factors associated with outcome in 55patients[J].Eur Radiol,2009,19(2):384-390.
[10]GANGLOFF A,LECLEIRE S,DI FIORE A,et al.Fully versus partially covered self-expandable metal stents in benign esophageal strictures[J].Diseases of the Esophagus,2015,28(7):678-683.
[11]BAKKEN J C,WONG KEE SONG L M,DE GROEN P C,et al.Use of a fully covered self-expandable metal stent for the treatment of benign esophageal diseases[J].Gastrointest Endosc,2010,72(4):712-720.
[12]SANDHA G S,MARCON N E.Expandable metal stents for benign esophageal obstruction[J].Gastrointest Endosc Clin NAm,1999,9(3):437-446.
[13]VAN HALSEMA E E,WONG KEE SONG L M,BARON T H,et al.Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases[J].Gastrointest Endosc,2013,77(1):18-28.
[14]SHIM C S,CHO Y D,MOON J H,et al.Fixation of a modified covered esophageal stent:its clinical usefulness for preventing stent migration[J].Endoscopy,2001,33(10):843-848.
[15]MANES G,CORSI F,PALLOTTA S,et al.Fixation of a covered self-expandable metal stent by means of a polypectomy snare:an easy method to prevent stent migration[J].Dig Liver Dis,2008,40(9):791-793.
[16]VANBIERVLIET G,FILIPPI J,KARIMDJEE B S,et al.The role of clips in preventing migration of fully covered metallic esophageal stents:a pilot comparative study[J].Surgical Endoscopy,2012,26(1):53-59.
[17]NGAMRUENGPHONG S,SHARAIHA R Z,SETHI A,et al.Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions:a comparative multicenter study[J].Endoscopy,2016,48(9):808.
[18]PESCARUS R,SHLOMOVITZ E,SHARATA A M,et al.Endoscopic suturing versus endoscopic clip closure of the mucosotomy during a per-oral endoscopic myotomy(POEM):a case-control study[J].Surg Endosc,2016,30(5):2132-2135.
[2]SHI Q,JU H,YAO L Q,et al.Risk factors for postoperative stricture after endoscopic submucosal dissection for superficial esophageal carcinoma[J].Endoscopy,2014,46(8):640-644.
[3]ONO S,FUJISHIRO M,NIIMI K,et al.Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms[J].Endoscopy,2009,41(8):661-665.
[4]鞠辉,钟芸诗,姚礼庆,等.早期食管癌内镜黏膜下剥离术后食管狭窄的危险因素分析[J].中华消化内镜杂志,2013,30(6):310-314.[4]JU H,ZHONG Y S,YAO L Q,et al.Risk factors of esophageal stricture after endoscopic submucosal dissection for early stage esophageal cancer[J].Chin J Dig Endosc,2013,30(6):310-314.Chinese
[5]ELOUBEIDI M A,TALREJA J P,LOPES T L,et al.Success and complications associated with placement of fully covered removable self-expandable metal stents for benign esophageal diseases(with videos)[J].Gastrointest Endosc,2011,73(4):673-681.
[6]SUZUKI T,SIDDIQUI A,TAYLOR L J,et al.Clinical outcomes,efficacy,and adverse events in patients undergoing esophageal stent placement for benign indications:a large multicenter study[J].J Clin Gastroenterol,2016,50(5):373-378.
[7]DAN D T,GANNAVARAPU B,LEE J G,et al.Removable esophageal stents have poor efficacy for the treatment of refractory benign esophageal strictures(RBES)[J].Diseases of the Esophagus,2014,27(6):511-517.
[8]CHAPUT U,HERESBACH D,AUDUREAU E,et al.Comparison of a standard fully covered stent with a super-thick siliconecovered stent for the treatment of refractory esophageal benign strictures:a prospective multicenter study[J].United European Gastroenterology Journal,2013,1(2):93-102.
[9]KIM H J,SONG H Y,CHOI E K,et al.Temporary metallic stent placement in the treatment of refractory benign esophageal strictures:results and factors associated with outcome in 55patients[J].Eur Radiol,2009,19(2):384-390.
[10]GANGLOFF A,LECLEIRE S,DI FIORE A,et al.Fully versus partially covered self-expandable metal stents in benign esophageal strictures[J].Diseases of the Esophagus,2015,28(7):678-683.
[11]BAKKEN J C,WONG KEE SONG L M,DE GROEN P C,et al.Use of a fully covered self-expandable metal stent for the treatment of benign esophageal diseases[J].Gastrointest Endosc,2010,72(4):712-720.
[12]SANDHA G S,MARCON N E.Expandable metal stents for benign esophageal obstruction[J].Gastrointest Endosc Clin NAm,1999,9(3):437-446.
[13]VAN HALSEMA E E,WONG KEE SONG L M,BARON T H,et al.Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases[J].Gastrointest Endosc,2013,77(1):18-28.
[14]SHIM C S,CHO Y D,MOON J H,et al.Fixation of a modified covered esophageal stent:its clinical usefulness for preventing stent migration[J].Endoscopy,2001,33(10):843-848.
[15]MANES G,CORSI F,PALLOTTA S,et al.Fixation of a covered self-expandable metal stent by means of a polypectomy snare:an easy method to prevent stent migration[J].Dig Liver Dis,2008,40(9):791-793.
[16]VANBIERVLIET G,FILIPPI J,KARIMDJEE B S,et al.The role of clips in preventing migration of fully covered metallic esophageal stents:a pilot comparative study[J].Surgical Endoscopy,2012,26(1):53-59.
[17]NGAMRUENGPHONG S,SHARAIHA R Z,SETHI A,et al.Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions:a comparative multicenter study[J].Endoscopy,2016,48(9):808.
[18]PESCARUS R,SHLOMOVITZ E,SHARATA A M,et al.Endoscopic suturing versus endoscopic clip closure of the mucosotomy during a per-oral endoscopic myotomy(POEM):a case-control study[J].Surg Endosc,2016,30(5):2132-2135.
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