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目的回顾性分析食管支架植入术治疗食管癌放疗后复发的并发症。方法食管癌放射治疗后复发患者24例,经X线透视引导下植入国产覆膜网状镍钛记忆合金支架,14例支架体部直径为18mm,10例支架体部直径为16mm。比较不同直径食管支架治疗后并发症发生率。结果 24例患者均一次成功植入支架。术后均有不同程度的胸痛,持续时间为3-30d。支架体部直径18mm组14例中,出现中、重度胸痛9例(64.3%),且持续时间长,轻度疼痛5例;食管穿孔1例,术后24h发现食管穿孔,CT显示液气胸,病情迅速加重而于24h后死亡;消化道大出血2例,其中1例发生在术后第28天,突发消化道大出血而死亡;另1例术后24h消化道出血,经药物止血、输血治疗1周后血止,2例均伴有长时间中度以上胸痛。支架体部直径16mm组10例中,中、重度胸痛2例(20%),轻度疼痛6例,未出现食管穿孔和消化道出血病例。存活病例术后1周复查食管造影,均未发现支架移位、脱落。结论食管癌放射治疗后复发的支架植入术能改善进食困难症状;但并发症发生率较高,采用小直径支架能降低严重并发症发生率。
Objective To retrospectively analyze the complications of esophageal stent implantation for esophageal cancer recurrence after radiotherapy. Methods Twenty-four patients with esophageal cancer recurrence after radiotherapy were treated with X-ray fluoroscopy. The mesh-shaped nickel-titanium memory alloy stent was implanted in 14 patients. The diameter of the stent was 18 mm in 14 cases and 16 mm in 10 cases. The incidence of complications after different esophageal stents were compared. Results All the 24 patients were successfully implanted stent. Postoperative chest pain of varying degrees, the duration of 3-30d. There were 9 cases (64.3%) of moderate and severe chest pain in the group of 18mm in diameter of stent body, and had long duration and mild pain in 5 cases. One case of esophageal perforation was found, and esophageal perforation was found at 24 hours after operation. CT, 2 cases of gastrointestinal bleeding occurred, of which 1 case occurred on the 28th day after surgery, sudden death of digestive tract bleeding; the other 1 case of postoperative 24h gastrointestinal bleeding, the drug to stop bleeding, blood transfusion therapy 1 week after the blood only, 2 cases were accompanied by prolonged moderate to severe chest pain. Stent body diameter 16mm group 10 cases, moderate and severe chest pain in 2 cases (20%), mild pain in 6 cases, no esophageal perforation and gastrointestinal bleeding cases. Survival cases 1 week after esophagectomy review, did not find stent displacement, fall off. Conclusion The stent implantation after esophageal cancer recurrence can improve the symptoms of eating difficulties. However, the incidence of complications is high. The use of small diameter stent can reduce the incidence of serious complications.