自膨式覆膜食管金属支架置入治疗难治性食管静脉曲张破裂出血的临床分析（附8例报告）

Clinical analysis of self-expandable metal stent in treatment of refractory esophageal variceal bleeding (8 cases)

摘要:

目的 评估自膨式覆膜食管金属支架（SEMS）置入治疗难治性食管静脉曲张破裂出血（EVB）的疗效和安全性。方法 回顾性分析2012年9月－2022年1月该院消化内科行SEMS置入治疗的8例难治性EVB患者的临床资料。分析SEMS置入治疗难治性EVB的手术成功率、即时止血率、再出血率和并发症发生情况。结果 所有患者均成功置入SEMS，未发生食管穿孔和死亡等严重并发症，成功率为100.0%（8/8），支架置入后，所有患者活动性出血立即停止，且24 h内未再出血，即时止血率为100.0%（8/8）。8例患者经SEMS治疗后5 d内均未再发出血，再出血率为0.0%（0/8）。所有患者术后均未出现出血加重和穿孔等严重并发症。8例患者中，有3例在术后第1、2和5天观察到支架移位，支架移位率为37.5%（3/8）。所有患者在支架取出后均未再发出血，支架移除后再出血发生率为0.0%（0/8）。结论 食管SEMS置入用于治疗难治性EVB，是一种可行、有效的止血方法，且不良事件少。值得临床推广应用。

Abstract:

Objective To evaluate the efficacy and safety of self-expandable metal stent (SEMS) in treatment of refractory esophageal variceal bleeding (EVB).Methods From September 2012 to January 2022, 8 patients with refractory EVB treated by SEMS were enrolled. The clinical data of all the patients were analyzed retrospectively, the surgical success rate, immediate hemostasis rate, rebleeding rate and complications were analyzed.Results All the patients were successfully implanted with SEMS and no serious complications such as esophageal perforation and death occurred. The success rate was 100.0% (8/8). All the patients with active bleeding stopped immediately after stent implantation, and there was no further bleeding within 24 h, with an immediate hemostasis rate of 100.0% (8/8). All of the 8 patients did not bleed within 5 d after SEMS treatment, and the rebleeding rate was 0.0% (0/8). No serious complications such as bleeding aggravation and perforation occurred in all patients after operation. Stent displacement was observed in 3 of the 8 patients, and the stent displacement rate was 37.5%(3/8). All the patients did not bleed after stent removal, and the incidence of rebleeding after stent removal was 0.0% (0/8).Conclusion Esophageal SEMS implantation for refractory EVB is a safe and effective hemostatic method with few adverse events. It is worthy of clinical application.