自膨胀金属支架(SEMS)是恶性吞咽困难患者快速缓解症状的首选姑息性治疗方法。越来越多的内窥镜引导的插入作为日常情况进行,并且不需要荧光透视引导。此连续病例系列报告了在英国大型专科食管胃部进行内窥镜引导的SEMS插入的11年经验。
从前瞻性维护的数据库中确定了2003年至2014年期间因恶性吞咽困难而接受支架插入的患者。患者人口统计数据,肿瘤特征,适应症,插入技术,并发症,并提取了重新干预的必要性,然后通过对电子病例记录的回顾性审查来证实。
总共362例中位年龄为76岁的患者在内窥镜引导下接受了原发性SEMS插入。26例患者在初次插入后30天内需要重复内镜干预,59例患者在初次插入后90天内需要重复内镜干预。Kaplan-Meier估计的再干预率为7.7%和20.3%,分别。较高的肿瘤与需要重复干预相关(p=0.014)。最常见的重复干预是插入新支架,最常见的是支架迁移或肿瘤过度生长。通过快速通路转诊的252名患者中,222名(88.1%)患者被支架植入为日间病例,该队列的30天再入院率与作为住院患者植入支架的患者无显著差异(p=0.774).三名(0.8%)患者出现穿孔,有一次与手术有关的死亡.
这个大型连续病例系列表明,内窥镜引导下的SEMS插入恶性吞咽困难可以有效地作为一个低并发症的日间病例进行。重新接纳,再干预率。
Self-expanding metal stents (SEMSs) are the palliative treatment of choice for rapid symptomatic relief in patients with malignant dysphagia. Increasingly endoscopically guided insertion is performed as a day
case and without the need for fluoroscopic guidance. This consecutive
case series
reports 11-year experience of endoscopically guided SEMS insertion in a large UK specialist oesophagogastric unit.
Patients undergoing stent insertion for malignant dysphagia between 2003 and 2014 were identified from a prospectively maintained database. Data on patient demographics, tumour characteristics, indications, technique of insertion, complications, and need for re-intervention were abstracted and then corroborated by retrospective review of electronic
case records.
A total of 362 patients with a median age of 76 years underwent primary SEMS insertion under endoscopic guidance. Repeat endoscopic intervention was required in 26 patients within 30 days and 59 patients within 90 days of primary insertion, giving Kaplan-Meier estimated re-intervention rates of 7.7 % and 20.3 %, respectively. Higher tumours were associated with need for repeat intervention (p = 0.014). The most frequent repeat intervention was insertion of a new stent, most commonly for stent migration or tumour overgrowth. Out of 252, 222 (88.1 %) patients referred through a rapid access pathway were stented as day cases, and the 30-day readmission rate in this cohort did not differ significantly from patients stented as inpatients (p = 0.774). Three (0.8 %) patients suffered a perforation, and there was a single procedure-related death.
This large consecutive
case series demonstrates that endoscopically guided SEMS insertion in malignant dysphagia can be performed efficiently as a day
case with low complication, readmission, and re-intervention rates.