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Esophageal Anti-reflux Stent in the Treatment ofGastroesophagostomic Stoma Stenosis and Cardiac Cancer
【Abstract】 Objective Modified esophageal anti-reflux stent was used in patients with gastroesophagostomic stoma stenosis andcardiac cancer in order to prevent potential reflux esophagitis due to conventional stent implantation.
Materials and Methods The modified stent was made of Nitinol and covered with a thin membrane, at its lower end it had an anti-reflux membrane.Results Antireflux stent implantation was performed in 35 patients. Symptoms of gastroesophageal reflux in these patients were markedly alleviated or completely disappeared.Conclusion Antireflux stent can effectively prevent the gastroesophageal reflux for acertain period.
【Key words】 Esophageal stenosis Stent Interventional therapy
1995年以来笔者将带防返流膜的食管内支架应用于临床,以解决食管胃吻合口狭窄以及贲门癌放置食管支架后引起胃食管返流,导致返流性食管炎的缺点。临床应用35例,经短期观察效果较好,现报告如下。
1 材料与方法
随机选择食管狭窄患者35例,男25例,女10例,年龄46~78岁。其中食管癌术后食管胃吻合口狭窄12例(手术后吻合口癌肿复发8例,手术后吻合口组织增生性纤维瘢痕狭窄4例),贲门癌23例。狭窄段长度0.7~6.3cm。采用硅橡胶薄膜覆盖的镍钛记忆合金编织而成的网格状食管支架(中国有色金属研究总公司),支架下口装置瓣膜防返流膜,该膜系与支架被膜同类的高强度硅橡胶膜制作而成,用硅胶粘合,连接牢固,有较好的抗酸碱腐蚀及抗机械摩擦的强度。其结构为支架下端喇叭口内连接一圆管状薄膜,薄膜远端呈3个半圆形瓣膜,食物通过时压力使瓣膜撑开,食物通过后,圆管状薄膜下端吸附靠拢,瓣膜互相贴合,阻止胃食管返流;瓣膜型支架在胃内压力增大时,瓣膜向上翻转形成向上的通道。用于食管胃吻合口的支架长6~8cm。用于贲门处的支架则根据病变长度再加长4cm左右,注意支架上端要到达膈食管裂孔上方,支架下口位于贲门下2~3cm的胃内;支架直径2.0~2.2cm。采用食管支架输送器放置支架。瓣膜型支架放置到位后,嘱患者饮数口凉开水使防返流膜展开。术后1周内进半流质饮食,分别于1周、1个月、6个月钡餐造影各复查1次。
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