消化道狭窄的内镜治疗PPT格式课件下载.ppt

消化道狭窄的内镜治疗PPT格式课件下载.ppt

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化疗：

5-Fu和顺铂为主和顺铂为主放疗：

外放射为主放疗：

外放射为主以手术为主的综合治疗以手术为主的综合治疗手术适应证早期食管癌早期食管癌中期（中期（）、中下段食管癌病变在）、中下段食管癌病变在5cm内，上段在内，上段在3cm内，全身情况好者内，全身情况好者中期（中期（）、病变在）、病变在5cm以上，无明显远处转移，以上，无明显远处转移，全身条件允许，可采用术前放化疗与手术综合疗法全身条件允许，可采用术前放化疗与手术综合疗法放射治疗后复发，病变范围尚不大，无远处转移，放射治疗后复发，病变范围尚不大，无远处转移，全身情况良好者全身情况良好者手术禁忌证手术禁忌证食管癌病变广泛或累及邻近器官如气管、食管癌病变广泛或累及邻近器官如气管、肺、纵隔等者肺、纵隔等者已有锁骨上窝淋巴结等远处转移者已有锁骨上窝淋巴结等远处转移者有严重心、肺或肝功能不全者有严重心、肺或肝功能不全者严重恶病质者严重恶病质者Surgicalresectionistheonlycurativetreatmentoptionforinvasiveesophagealcancer.However,despitecarefulstagingandadvancesinadjuvanttherapyandsurgicaltechniques,5-yearsurvivalratesrarelyexceed40%.1,2Manypatientspresentwithlocoregionalrecurrenceanddistantmetastasiswithin2yearsaftercurativeesophagectomy.3Treatmentofpatientswithlocaldiseaserecurrenceaimsatrelievingdysphagia食管气管瘘金属支架置放术复查碘油造影未见造影剂瘘出。

EsophagealdiseasesandtypesofSEMSusedUUCUEGZWEsophagealcarcinomaCervical（n=14）77Thoracic（n=93）3147735G-Ejunction（n=79）442627Locallyrecurrentcarcinoma1236（n=48）Achalasia（n=8）44UU,UncoveredUltraflex（BostonScientific,Boston,Mass.）;

CU,coveredUltraflex（BostonScientific）;

E,Esophacoil（InstentInc.,EdenPrarie,Minn.）;

GZ,GianturcoZ-stent（CookInc.,Bloomington,Ind.）;

W,Wallstent（BostonScientific）.Factorsthatmaypredisposetoesophagealstentmigration:

multivariateanalysisNMigration（%）pvalueGenderFemale588/13（61.5）0.0038StrictureTC802/13（15.4）0.954GEJ679/13（11.4）0.017EAC82/13（25）0.625PrevioustherapyS+B42/13（15.4）0.997R102/13（15.4）0.997Dilation10mm246/13（46.1）0.000StentGZ32/13（15.4）0.719E124.13（30.7）0.104UU874/13（30.7）0.169CU953/13（23.0）0.166TC,Esophagealthoraciccarcinoma;

GEJ,carcinomaofthegastroesophagealjunction;

EAC,esophagealachalasia;

S+B,surgery&

balloondilation;

R,radiotherapy;

GZ,GianturcoZ-stent;

E,Esophacoil;

UU,uncoveredUltraflex;

CU,coveredUltraflex（GastrointestEndosc2001;

53:

96-97.）EsophagealstentsformalignantstricturesclosetotheupperesophagealsphincterGastrointestEndosc2007;

66:

1082-90EsophagealstentsforthepalliationofmalignantdysphagiaandfistularecurrenceafteresophagectomyLuminalpatency.Themediansurvivaltimeafterstentingforallpatientswithstenosiswas70days（range1dayto34months）.Stentinsertionwastechnicallysuccessfulinallbut1patient（98%）（Fig.1）.Mediandurationofprimarystentpatencywas56days（range1dayto33months）（Fig.2）.Atotalof20episodesofstentdysfunctionoccurredin18（27%）of66patientsatamedianof38dayspost-SEMSinsertion（range2-406days）.Stentdysfunctionwascausedbytissuein-orovergrowth（n8）,stentmigration（n9）,andfoodimpaction（n3）.Tissuein-andovergrowthoccurredatamedianof119dayspost-SEMSinsertion（range33297days）;

5patientsweresuccessfullytreatedwithasecondSEMS.Six（24%）of25fullycoveredstentsversus3（7%）of41partiallycoveredSEMSmigrated（P.07）atamediantimeintervalof66daysafterSEMSinsertion（range12-406days）.Ofthesepatients,6patientsrequiredasecondSEMS.Foodbolusimpactionoccurredin3（20%）patientsatamediantimeintervalof11daysafterSEMSinsertion;

all3weresuccessfullyclearedendoscopically.InsertionofasecondSEMSwassuccessfulinallpatients（100%）.Medianpatencyofthesestentswas59days（range5286days）Fistulasealing.Themediansurvivaltimeofpatientswithmalignantfistulacausedbytumorrecurrencewas73days（range10daysto91months）.Thecoatedsegmentofthestenteffectivelysealedfistulaeinallbut1patient（93%）.Thispatientwassuccessfullytreatedwithasecondstent.Stentdysfunctionoccurredin6（40%）of15patients.In5（33%）patients,additionalstentsweresuccessfullyinsertedtomanagestentmigration（n4）andpersistentleakageduringstenttreatment（n1）.Two（22%）of9fullycoveredstentsversus2（33%）of6partiallycoveredSEMSsmigratedatamediantimeintervalof5monthspost-SEMSinsertion（range5daysto11months）.Foodbolusimpactionoccurredin1patient17dayspost-SEMSinsertion,thispatientwasalsosuccessfullytreatedendoscopicallybystentclearance.OverallcomplicationsMildcomplicationsafterstentplacementoccurredin7（9%）patientsincludingretrosternalpainandsymptomaticgastroesophagealreflux.Majorcomplicationsoccurredin9（11%）patients.Stridordevelopedimmediatelyafterinsertionin3patientswithalesionwithin4cmoftheupperesophagealsphincter.Inall3patients,thestentwasremoved,andtheyweremanagedconservatively.ThreepatientshadanupperGIhemorrhagefromthetumorsiteatamediantimeintervalof26daysafterS