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目的探讨不同部位消化道梗阻的内支架治疗特点与对策。方法消化道恶性梗阻63例采用71枚内支架治疗,全部使用永久性部分带膜镍钛合金支架,均在数字减影血管造影(d igital subtraction angiography,DSA)监视下经口或肛门将支架置于梗阻部位,预扩张和后扩张分别为6例和3例,术前术后均做造影对照,根据进食和排便情况评价疗效,并做临床随访3~24个月,平均11个月。结果单次成功放置支架60例;胃窦部、十二指肠空肠曲及乙状结肠首次操作失败再次置入支架各1例。56例上消化道支架置入后恢复饮食47例,7例乙状结肠和直肠支架置入后肠梗阻症状即刻解除;8例食管-支气管瘘置入食管支架后瘘管完全封堵;1例残胃-纵隔-支气管瘘置入支气管支架后轻度呛咳,3周后瘘口基本闭塞。出现剧烈疼痛1例,轻度疼痛12例,大出血1例,支架移位2例,术后再狭窄2例,声音嘶哑1例。结论部分带膜镍钛合金支架置入术是消化道恶性梗阻和食管-支气管瘘的有效治疗方法。但对不同部位消化道恶性梗阻均应区别对待,必须使用相应的材料和操作方法,以提高其有效性和安全性。
Objective To investigate the characteristics and countermeasures of treatment of gastrointestinal tract obstruction with different stents. Methods Sixty-one patients with malignant obstruction of the digestive tract were treated with 71 stents. All of them were treated with permanent partial nitinol stents, all under the surveillance of digital subtraction angiography (DSA) In the obstructive site, pre-dilatation and post-dilatation were 6 cases and 3 cases respectively. All patients underwent contrast imaging before and after surgery. The curative effect was evaluated according to the conditions of eating and defecation. The patients were followed up for 3 to 24 months with an average of 11 months. Results A total of 60 stents were successfully placed in one single stent. One case of stent was placed in the antrum, duodenum jejunum and sigmoid. Forty-six cases of upper gastrointestinal stents were reinfused and 47 cases were re-fed. The bowel obstruction symptoms were relieved immediately after implantation of the sigmoid colon and rectal stents in 7 cases. The fistulas were completely blocked after esophageal stent placement in 8 cases. Mediastinum - bronchial fistula into the bronchial stent mild cough, fistula occlusion after 3 weeks. One case of severe pain, mild pain in 12 cases, 1 case of bleeding, stent displacement in 2 cases, 2 cases of restenosis, hoarseness in 1 case. Conclusion Partial nitinol stent implantation is an effective treatment of malignant gastrointestinal obstruction and esophageal-bronchial fistula. However, different parts of the digestive tract malignant obstruction should be treated differently, we must use the appropriate materials and methods of operation to improve its effectiveness and safety.