儿童难治性食管狭窄应用全覆膜支架治疗的并发症及处理对策*

Complications and its management of refractory esophageal strictures treating with nitinol self-expandable metal stent in children*

摘要:

目的 探讨应用镍钛合金全覆膜食管支架治疗儿童难治性食管狭窄的并发症及处理对策。 方法 回顾性分析2009 年5 月-2016 年12 月于该院应用镍钛合金网格编织型的覆膜支架治疗9 例难治性食 管狭窄患儿的临床资料, 支架置入术后定期随访, 观察患儿支架置入后的效果及并发症等。结果 9 例患儿 均成功行支架置入术，所有患儿置入后狭窄梗阻症状均得到明显缓解；术后1~7 d 所有患儿均有呕吐及不同 程度的胸痛症状；1 例患儿置入后因哭闹不安不能忍受于术后36 h 取出支架；2 例于支架取出3 个月后出现 再狭窄，其中1 例并发肉芽组织增生；1 例食管穿孔患儿支架置入术1 周出现支架移位贴壁不良，原支架取出 后重置新支架，2 个月后再行支架取出，瘘口愈合。结论 镍钛合金全覆膜金属支架治疗儿童难治性良性食管 狭窄安全有效, 但与支架置入相关的并发症不容忽视，支架个体化设计与并发症的及时处理对提高临床疗效 至关重要。

Abstract:

Objective To investigate the complications and management of nitinol self-expandable metal stent (cSEMS) in treatment of refractory esophageal strictures in children. Methods The clinical data were reviewed for 9 pediatric patients with refractory benign esophageal disorders from May 2009 to December 2016, specially designed cSEMS were applied to them, data about effects and complications were collected during regular followups. Results Successful cSEMS placement was performed in 9 children, the symptom of dysphagia was obviously alleviated after implantation, all patients underwent vomiting and chest pain 1~7 days after operation; 1 case could not put up with the pain, so the stent had to be removed in 36 hours after implantation; 2 cases developed a recurrent stricture within 3 months after stent removal, growth of mild granulation tissue was found in 1 case; In the case with esophageal fistulas, migration and poor adherence to the esophagus was occurred in 3 days after implantation, then a new designed cSEMS with bigger proximal tip was planted in the same place 1 week later, 2 months after stent removed, fistula was healed. Conclusion Placement of cSEMS is safe and effective in treating pediatric patients with refractory esophageal stricture. However, complications associated with stent placement should not be ignored, individually designed stent and timely management of the complications are quite important in order to enhance clinical efficacy.