食道支架的併發症與存活分析

Complications and survival analysis after esophageal stent placement

李憲斌(Hsien-Pin Li)

指導教授 ： 周世華

高雄醫學大學/醫學院/臨床醫學研究所碩士班/碩士(2019年)

摘要

目的
食道支架為處理腫瘤所造成的惡性食道狹窄與食道廔管的重要介入方式，但金屬食道支架的置放也可能伴隨相關的風險與併發症，本研究的目的在探討接受食道支架治療的病人在中長期的追蹤後其相關的存活率，併發症與危險因子。
方法
於2007年10月至2017年10月期間，共有98位病人接受食道支架置放手術，其適應症為良性疾病或惡性腫瘤所造成的食道狹窄，食道廔管，食道破裂或食道重建的吻合處滲漏。食道支架置放的適應症，早期與晚期的併發症與處理方式，存活時間都以回朔性研病歷與相關影像紀錄並加以進一步比較分析。
結果
在98位病人共放置了103個食道金屬支架，其中79位是食道癌所造成的狹窄或廔管。平均追蹤時間為86天(2-1890天)。支架置放後第一、三、六個月的存活率分別為為 88%，47%與22%。與支架相關的併發症最多為肺炎佔32%，新發廔管或廔管惡化有19%，而臨床上嚴重出血有18%。
結論
食道支架雖然對食道狹窄或廔管有立竿見影的效果，但是短期與長期的併發症偏高，而嚴重致命的併發症如出血可能毫無預警的發生，因此建議謹慎評估並使用於預期存活時間有現的病人上。

關鍵字

食道支架

並列摘要

Objectives: The aim of this study was to report single medical center experience of esophageal stents. We analyze the esophageal stent associated complications, life quality and survival.
Methods: Ninety-eight patients with esophageal disease treated with esophageal stent at our institute between October 2007 and October 2017. The indication of esophageal stent placement included malignant or benign esophageal stenosis, fistula formation, esophageal perforation and anastomosis leakage after esophageal operation. Esophageal stent placement was performed under general anesthesia in the operation room under endoscopic view guided and C-arm monitoring during release. The indications, early and late complications, and survival were collected and analyzed retrospectively.
Results: For the 98 patients who underwent esophageal stent, 103 stents all were performed successfully. Esophageal cancer with dysphagia or fistula was major indications which including 79 patients. The median length of follow-up was 86 days(2-1890days). The overall post-stent patient survival was 88% at 1 month, 47% at 3 months and 22% at 6 months. Stent-related complications including pulmonary infection in 31 patients (32%), new/worsening fistula in 19 patients (19%), and major bleeding episodes in 18 patients (18%). Additional procedures were need in 15 patients. (15%)
Conclusions: The efficacy of esophageal stent is still in doubts. Esophageal stents provide short-term symptom relief with high complication rate. Dangerous complications may happen with little warning. We suggest only use in very limit life expectancy patients.

並列關鍵字

esophageal stent

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