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J Zhejiang Univ (Med Sci)  2018, Vol. 47 Issue (6): 643-650    DOI: 10.3785/j.issn.1008-9292.2018.12.13
    
Efficacy and safety of digestive tract stent placement under direct visual endoscopy without X-ray monitoring in treatment of digestive tract stricture
SHEN Hong(),JI Feng*()
Department of Gastroenterology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Abstract  

Objective: To evaluate the efficacy and safety of digestive tract stent implantation under direct visual endoscopy without X-ray monitoring in the treatment of digestive tract stricture. Methods: The clinical data of patients undergoing digestive tract stent placement under direct visual endoscopy without X-ray monitoring in the First Affiliated Hospital of Zhejiang University School of Medicine from March 2003 to November 2017 were retrospectively analyzed. The process of procedures, the postoperative complications and the postoperative follow-up data were documented. The survival time of patients with malignant gastrointestinal stricture was compared between those with and without stent implantation. Results: Among 562 patients, there were 310 cases of esophagus and cardia stricture, 40 cases of gastroduodenus stricture, 212 cases of colorectum stricture, and 63 cases with esophagus-tracheal fistula, esophagus-mediastinal fistula or anastomotic fistula. The stents were implanted successfully in 560 cases (99.64%) and the symptoms were alleviated in all patients after stent implantation (100%). Postoperative substernal discomfort, chest pain or abdominal pain occurred in 26 cases (4.64%), bleeding in 18 cases (3.21%), displacement of esophageal stents in 9 cases (1.61%), and restenosis in 15 cases (2.68%), in whom the stents were successfully placed again. None of the patients died within 7 days after the procedure. The incidence of postoperative abdominal pain, bleeding and stent displacement in esophageal/cardiac stricture patients was higher than that in the colorectal stricture patients (P < 0.05). In 284 cases of malignant stenosis, the median survival time of colorectal stricture patients[(27.5±1.94) months] was significantly higher than that of esophagus/cardia stricture patients[(13.40±0.71) months] and gastroduodenal stricture patients[(11.00±1.78) months]. The survival time of stenting patients with upper gastrointestinal malignant stenosis was significantly longer than that of the non-stenting patients (P < 0.05). Conclusion: Stent implantation under direct visual endoscopy without X-ray monitoring is safe and effective for the treatment of benign and malignant stricture of digestive tract and closure of fistula.



Key wordsEndoscopy, gastrointestinal      Digestive system neoplasms/therapy      Digestive system fistula/therapy      Constriction, pathologic/therapy      Stents      Treatment outcome      Safety      Retrospective studies     
Received: 05 April 2018      Published: 15 March 2019
CLC:  R57  
Corresponding Authors: JI Feng     E-mail: 158767328@qq.com;jifeng@zju.edu.cn
Cite this article:

SHEN Hong,JI Feng. Efficacy and safety of digestive tract stent placement under direct visual endoscopy without X-ray monitoring in treatment of digestive tract stricture. J Zhejiang Univ (Med Sci), 2018, 47(6): 643-650.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2018.12.13     OR     http://www.zjujournals.com/med/Y2018/V47/I6/643


无X射线监视内镜下消化道支架置入治疗消化道狭窄的疗效和安全性

目的: 评价无X射线监视内镜下消化道支架置入治疗消化道狭窄的疗效及安全性。方法: 回顾性分析浙江大学医学院附属第一医院2003年3月至2017年11月所有无X射线监视全程内镜直视下消化道支架置入治疗消化道狭窄患者的资料库,详细记录手术经过、疗效、术后并发症及随访情况,比较恶性肿瘤患者与同期未行支架置入的消化道恶性狭窄患者的生存时间。结果: 562例患者中,食管、贲门狭窄310例,胃、十二指肠狭窄40例,结、直肠狭窄212例,其中合并食管气管狭窄、食管纵隔瘘、吻合口瘘共63例。成功置入支架560例(99.64%),症状缓解有效率达100%。术后胸骨后不适、胸痛、腹痛26例(4.64%),消化道出血18例(3.21%),食管支架移位后再调整9例(1.61%),支架再次狭窄15例(2.68%),均再次成功放置支架。术后7 d无患者死亡。食管、贲门狭窄组术后胸/腹痛、出血、支架移位的发生率高于结、直肠狭窄组(均P < 0.05)。284例恶性狭窄中,食管、贲门狭窄组,胃、十二指肠狭窄组,结、直肠狭窄组的中位生存时间分别为(13.40±0.71)、(11.00±1.78)、(27.50±1.94)个月,其中直肠恶性狭窄组的中位生存时间明显长于食管、贲门恶性狭窄组及胃、十二指肠恶性狭窄组(均P < 0.05)。与同期未行支架置入术的上消化道恶性狭窄患者比较,食管、贲门狭窄组及胃、十二指肠狭窄组置入支架术后患者生存时间明显提高(均P < 0.05)。结论: 无X射线监视全程内镜直视下消化道支架置入治疗消化道良恶性狭窄及封堵瘘口简便、准确、安全、有效。


关键词: 内窥镜检查, 胃肠道,  消化系统肿瘤/治疗,  消化系统瘘/治疗,  缩窄, 病理性/治疗,  支架,  治疗结果,  安全,  回顾性研究 
Fig 1 Stent implantation for esophagus
Fig 2 Stent implantation for duodenum
Fig 3 Stent implantation for colon
[n(%)或($\bar x \pm s$)]
组别 n 吞咽困难分级 平均级数
0级 1级 2级 3级 4级
与术前比较, *P < 0.05, **P < 0.01.
食管、贲门狭窄 术前 310 0 0 0 256 54 3.17±0.38
术后 310 9 224 75 2 0 1.23±0.50**
胃、十二指肠狭窄 术前 40 0 0 0 8 32 3.68±0.47
术后 40 16 21 3 0 0 0.62±0.59*
Tab 1 Comparison of clinical symptoms before and after stent implantation in patients with esophageal and cardia stenosis or stomach and duodenal stenosis
[n(%)]
与食管、贲门狭窄组比较, *P < 0.05.
组别 n 胸/腹痛 消化道出血 支架移位 再狭窄 呃逆 咳嗽 气急 合计
食管、贲门狭窄组 310 19(6.1) 6(1.9) 9(2.9) 11(3.6) 3(1.0) 4(1.3) 1(0.3) 53(17.1)
胃、十二指肠狭窄组 40 3(7.5) 1(2.5) 0(0.0)* 2(5.0) 0(0.0) 0(0.0) 0(0.0) 6(15.0)
结、直肠狭窄组 210 4(1.9)* 11(5.2)* 0(0.0)* 2(1.0) 0(0.0) 0(0.0) 0(0.0) 17(8.1)*
合计 560 26(4.6) 18(3.2) 9(1.6) 15(2.7) 3(0.5) 4(0.7) 1(0.2) 76(13.6)
Tab 2 Adverse reaction and complications after stent implantation in three groups
Fig 4 Survival curves of patients with malignant stricture of gastrointestinal tract
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