消化道狭窄的内镜治疗PPT格式课件下载.ppt

1、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、

2、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Surgical resection is the only curative treatment optionfor invasive esophageal cancer.However,despite carefulstaging and advances in adjuvant therapy and surgicaltechniques,5-year survival rates rarely

3、 exceed 40%.1,2Many patients present with locoregional recurrence anddistant metastasis within 2 years after curative esophagectomy.3 Treatment of patients with local disease recurrenceaims at relieving dysphagia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。Esophageal diseases and types of SEMS used UU CU E GZ WEsophag

4、eal carcinoma Cervical（n=14）7 7 Thoracic（n=93）31 47 7 3 5 G-E junction（n=79）44 26 2 7 Locally recurrent carcinoma 12 36 （n=48）Achalasia（n=8）4 4 UU,Uncovered Ultraflex（Boston Scientific,Boston,Mass.）;CU,covered Ultraflex（Boston Scientific）;E,Esophacoil（Instent Inc.,Eden Prarie,Minn.）;GZ,Gianturco Z-s

5、tent（Cook Inc.,Bloomington,Ind.）;W,Wallstent（Boston Scientific）.Factors that may predispose to esophageal stent migration:multivariate analysis N Migration（%）p value Gender Female 58 8/13（61.5）0.0038Stricture TC 80 2/13（15.4）0.954 GEJ 67 9/13（11.4）0.017 EAC 8 2/13（25）0.625Previous therapy S+B 4 2/13

6、（15.4）0.997 R 10 2/13（15.4）0.997Dilation 10 mm 24 6/13（46.1）0.000Stent GZ 3 2/13（15.4）0.719 E 12 4.13（30.7）0.104 UU 87 4/13（30.7）0.169 CU 95 3/13（23.0）0.166TC,Esophageal thoracic carcinoma;GEJ,carcinoma of the gastroesophageal junction;EAC,esophageal achalasia;S+B,surgery&balloon dilation;R,radiothe

7、rapy;GZ,Gianturco Z-stent;E,Esophacoil;UU,uncovered Ultraflex;CU,covered Ultraflex（Gastrointest Endosc 2001;53:96-97.）Esophageal stents for malignant strictures close to the upper esophageal sphincterGastrointest Endosc 2007;66:1082-90Esophageal stents for the palliation of malignant dysphagia and f

8、istula recurrence after esophagectomyLuminal patency.The median survival time afterstenting for all patients with stenosis was 70 days（range 1day to 34 months）.Stent insertion was technically successful in all but 1 patient（98%）（Fig.1）.Median duration of primary stent patency was 56 days（range 1 day

9、 to 33 months）（Fig.2）.A total of 20 episodes of stent dysfunction occurred in 18（27%）of 66 patients at a median of 38 days post-SEMS insertion（range 2-406 days）.Stent dysfunction was caused by tissue in-or overgrowth（n 8）,stent migration（n 9）,and food impaction（n 3）.Tissue in-and overgrowth occurred

10、 at a median of 119 days post-SEMS insertion（range 33297 days）;5 patients were successfully treated with a second SEMS.Six（24%）of 25 fully covered stents versus 3（7%）of 41 partially covered SEMS migrated（P .07）at a median time interval of 66 days after SEMS insertion（range 12-406 days）.Of these pati

11、ents,6 patients required a second SEMS.Food bolus impaction occurred in 3（20%）patients at a median time interval of 11 days after SEMS insertion;all 3 were successfully cleared endoscopically.Insertion of a second SEMS was successful in all patients（100%）.Median patency of these stents was 59 days（r

12、ange 5286 days）Fistula sealing.The median survival time of patients with malignant fistula caused by tumor recurrence was 73 days（range 10 days to 91 months）.The coated segment of the stent effectively sealed fistulae in all but 1 patient（93%）.This patient was successfully treated with a second sten

13、t.Stent dysfunction occurred in 6（40%）of 15 patients.In 5（33%）patients,additional stents were successfully inserted to manage stent migration（n 4）and persistent leakage during stent treatment（n 1）.Two（22%）of 9 fully covered stents versus 2（33%）of 6 partially covered SEMSs migrated at a median time i

14、nterval of 5 months post-SEMS insertion（range 5 days to 11 months）.Food bolus impaction occurred in 1 patient 17 days post-SEMS insertion,this patient was also successfully treated endoscopicallyby stent clearance.Overall complications Mild complications after stent placement occurred in 7（9%）patien

15、ts including retrosternal pain and symptomatic gastroesophageal reflux.Major complications occurred in 9（11%）patients.Stridor developed immediately after insertion in 3 patients with a lesion within 4 cm of the upper esophageal sphincter.In all 3 patients,the stent was removed,and they were managed conservatively.Three patients had an upper GI hemorrhage from the tumor site at a median time interval of 26 days after S