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目的探讨国产镍钛合金覆膜支架治疗晚期食管癌、贲门癌狭窄及食管瘘的相关植入技术,并发症的预防和处理以及临床疗效。方法选择158例晚期食管癌、贲门癌狭窄及食管瘘患者,利用胃镜与X线机结合进行食管内覆膜支架治疗,观察患者的术后并发症发生及肿瘤治疗情况,并定期进行随访。结果 158例患者中,156例放置成功,成功率98.7%,吞咽受阻得到缓解。支架植入后的并发症有胸骨后疼痛、发热、胃食管反流、出血、支架下滑移位、管腔再狭窄及纵隔炎(或脓肿)等。随访141例生存期为5～37个月,中位生存时间为11.5个月。其中单放支架69例生存时间为5～16个月,中位生存时间为9.6个月;支架配合放疗72例,生存时间为7～37个月,中位生存时间为15.6个月;中位生存时间比较,差异有统计学意义(P<0.01)。支架配合放疗近期疗效为CR率48.6%,PR率34.7%,有效率为83.3%;SD率16.7%;1、2、3年生存率分别为54.2%,31.9%,13.9%。结论覆膜支架治疗晚期食管癌、贲门癌狭窄及食管瘘,生物相容性好,吞咽困难缓解率高,生活质量明显改善。支架植入相关技术是预防和减少并发症的关键,支架配合放疗近期疗效显著,可明显延长生存时间。
Objective To investigate the related implantation techniques of domestic nitinol-coated stents in the treatment of advanced esophageal and gastric cardia stenosis and esophageal fistula, the prevention and treatment of complications and the clinical curative effect. Methods 158 cases of advanced esophageal cancer, cardia cancer stenosis and esophageal fistula patients were treated with endoscopic esophageal stent combined with X-ray machine to observe the postoperative complications and tumor treatment, and regular follow-up. Results Among the 158 patients, 156 cases were successfully placed with a success rate of 98.7% and the swallowing obstruction was relieved. Complications following stent implantation include retrosternal pain, fever, gastroesophageal reflux, bleeding, stenting of the stent, luminal restenosis, and mediastinitis (or abscess). Follow-up 141 cases of survival of 5 to 37 months, the median survival time was 11.5 months. Among them, 69 patients in single stent had a survival time of 5 to 16 months and a median survival time of 9.6 months. Stent with radiotherapy in 72 patients had a survival time of 7 to 37 months and a median survival time of 15.6 months. Survival time, the difference was statistically significant (P <0.01). The recent curative effect of stent combined with radiotherapy was CR rate of 48.6%, PR rate of 34.7%, effective rate of 83.3%, SD rate of 16.7%, and the 1, 2, 3-year survival rates were 54.2%, 31.9% and 13.9%, respectively. Conclusion The stent-graft treatment of advanced esophageal cancer, cardiac cancer stenosis and esophageal fistula, good biocompatibility, difficulty swallowing rate of high, quality of life improved significantly. Stent implantation related technology is the key to prevent and reduce complications, stent with radiotherapy in the near future significant effect, can significantly prolong survival time.