国产被覆自膨式金属内支架对食管瘘的临床应用.doc

国产被覆自膨式金属内支架对食管瘘的临床应用 【关键词】 支架 【摘要】 目的 评价国产被覆自膨式金属内支架治疗恶性食管瘘的效果和适用性。方法 利用DSA高清晰度X线电视造影、定位和监视释放。经口在0.038直头导丝引导下对癌性食管瘘36例置入双喇叭型国产被覆自膨式金属内支架，随访3～12个月。结果 全部病例均顺利置入支架，不仅有效地缓解了进食困难，改善了营养状况，同时还使气管食管瘘及食管纵隔瘘患者瘘口封闭，为减轻感染及进一步治疗造成狭窄的原发病提供了时机。结论 覆膜食管内支架置入术是一种治疗食管瘘安全有效的方法。国产支架操作简单，成功率高，安全效果立竿见影，价格低廉，能为众多患者接受。 【关键词】 支架；治疗学；食管瘘 Application of nationalmade covered metallic selfexpansible stents for the treatment of malignant esophageal fistula WANG Li,LIU Jingzhang,WANG Zixuan,et al. Department of Radiology,Qingdao Peoples Hospital,Qingdao 266001,China 【Abstract】 Objective To evaluate the therapeutic effect of nationalmade covered metallic expansibleself stents on malignant esophagotrachedal fistula.Methods 36 cases of malignant esophagotrachedal fistula were inplanted double homed stents.The operation was performed under DSA and followed up for 3～12 months.Results All stents were placed successfully.The symptoms of dysphagia in all cases were relieved so effectively that the food intake ability and nutrition of all patients were improved and fistulous ora of the patients with esophagotrachedal fistula were closed,so that improved the opportunities for the treatment of infections and diseases which caused esophageal stricture.Conclusion Esophageal stent inplantation is safe and effective treatment for malignant esophagotrachedal fistula.It is safer and easier operation with lower price and higher successful rates to use nationalmade stents than foreign stents. 【Key words】 stents;therapeutics;esophageal fistula 食管瘘多因食管癌溃疡穿通或放疗损伤所致，个别因肺癌侵犯纵隔而引起，其发生率约5%～10%［1］。恶性气管食管瘘是临床上非常棘手的复杂病症，多数患者因饥饿、吸入性肺炎、窒息而在短期内死亡［2］，食管内支架留置术治疗气管食管瘘1990年由德国医生Domschke等首先报道［3，4］。近几年，随着内支架材料结构的不断改进，目前正开始广泛用于临床。我院采用覆膜支架治疗36例食管瘘的患者，收到了较好的治疗效果，报告如下。 1 临床资料 1.1 一般资料 本组36例患者，男34例，女2例，年龄36～89岁，平均67.2岁。气管食管瘘20例，食管支气管瘘14例，食管纵隔瘘2例。36例中由肺癌浸润食管纵隔引起2例，由食管癌溃疡穿通引起18例，由食管癌放疗后引起16例。 1.2 器械 采用国产镍钛记忆合金网状带膜支架及支架置入器（北京有色金属研究总院制造），规格20mm×（80～120）mm；0.038直头导引钢丝（日本泰尔茂公司，长度260）；5F Cobra导管（美国COOK公司）；1000mA DSA造影机（德国，西门子）。 1.3 操作方法 1.3