grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-46252686-7370Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2019-178-6-23-28grekov-1180Research ArticleВОПРОСЫ ОБЩЕЙ И ЧАСТНОЙ ХИРУРГИИPROBLEMS OF GENERAL AND SPECIAL SURGERYСТЕНТИРОВАНИЕ ПИЩЕВОДА ПРИ ОПУХОЛЕВЫХ СТЕНОЗАХ (опыт трехлетней работы)ESOPHAGEAL STENTING FOR MALIGNANT STENOSIS (three-year outcomes)https://orcid.org/0000-0001-7700-2379АванесянА. А.AvanesyanA. A.

канд. мед. наук, зав. отделением эндоскопии,

Санкт-Петербург

Cand. Sci. (Med.), Head, Department of Endoscopy,

Saint-Petersburg

albina-md@mail.ruhttps://orcid.org/0000-0002-3570-808XПоповаН. С.PopovaN. S.

врач отделения эндоскопии,

Санкт-Петербург

doctor, Department of Endoscopy,

Saint-Petersburg

natalepopova@gmail.comhttps://orcid.org/0000-0002-2548-9469МирошниковБорис ИвановичMiroshnikovB. I.

д-р мед. наук, профессор, врач-хирург-эксперт,

Санкт-Петербург

Dr Sci. (Med), Surgery Expert,

Saint-Petersburg

matata_@mail.ruhttps://orcid.org/0000-0003-2024-681XМоисеенкоВ. М.MoiseenkoV. M.

д-р мед. наук, профессор, директор,

Санкт-Петербург

Dr Sci. (Med), Prof., Chief,

Saint-Petersburg

moiseyenkov@gmail.comГосударственное бюджетное учреждение здравоохранения «Санкт-Петербургский клинический научно-практический центр специализированных видов медицинской помощи (онкологический)»РоссияSaint-Petersburg clinical scientific and practical center for specialized types of medical care (oncological)Russian Federation20190912201917862328Copyright © Аванесян А.А., Попова Н.С., Мирошников Б.И., Моисеенко В.М., 20202020Аванесян А.А., Попова Н.С., Мирошников Б.И., Моисеенко В.М.Avanesyan A.A., Popova N.S., Miroshnikov B.I., Moiseenko V.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/1180ЦЕЛЬ

ЦЕЛЬ. Рассмотреть основные проблемы и наметить пути оптимизации стентирования пищевода при его раковом поражении с позиций собственного опыта.

МЕТОДЫ И МАТЕРИАЛЫ

МЕТОДЫ И МАТЕРИАЛЫ. Стентирование пищевода при дисфагии, вызванной раковым поражением, произведено у 103 больных.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Ранние осложнения наблюдали у 9 (8,7 %) больных: перфорация опухоли – 1 (0,97 %), кровотечение легкой степени – 2 (1,9 %), миграция стента – 6 (5,8 %). Непосредственный клинический эффект – устранение дисфагии, с учетом ликвидированных осложнений – был достигнут у всех 103 (100 %) больных. Поздние осложнения развились у 40 (38,8 %) больных: рецидив дисфагии – 27 (26,2 %), миграция стента – 2 (1,9 %), пищеводные свищи различного характера – 5 (4,9 %), профузные кровотечения – 6 (5,8 %). Наиболее тяжелые жизнеопасные осложнения развивались на 3–4-м месяцах после стентирования. Средний показатель выживаемости больных после стентирования составил 131 день (12–546 дней). Медиана выживаемости – 109 дней.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Непосредственная эффективность стентирования составила 100 %, а в отдаленные сроки наблюдения – 73,8 %. Химиолучевая терапия способствует увеличению продолжительности жизни больных и, в то же время, увеличению числа поздних осложнений после стентирования пищевода. 

OBJECTIVE of the study was to analyze the main problems and try to find the ways to improve the esophageal stenting for malignant stenosis with regard to our experience.

METHODS AND MATERIALS

METHODS AND MATERIALS. Palliative esophageal stenting for malignant dysphagia realized in 103 patients with observing all the patients till the fatal outcome.

RESULTS

RESULTS. Early complications were observed in 9 patients (8.7 %) among which were: perforation of esophagus – 1 (0.97 %), minor bleeding – 2 (1.9 %), stent migration – 6 (5.8 %). Elimination of dysphagia as an immediate clinical effect was achieved in all of 103 patients (100 %) among all of early complications included. Delayed sequelae were found in 40 patients (38.8 %) among which were recurrent dysphagia because of tissue in-/overgrowth – 27 (26.2 %), stent migration – 2 (1.9 %), different kinds of esophageal fistulae – 5 (4.9 %), major bleeding – 6 (5.8 %). The most severe life-threatening complications developed at 109 days after stent placement. The mean survival rate was 131 days (from 12 till 546 days).

CONCLUSION

CONCLUSION. Immediate clinical effect of stenting was achieved in 100 % of cases and delayed clinical effect was in 73.8 % of patients. Chemoradiotherapy conduces to increase the mean survival rate and, at the same time, to increase the most severe delayed life-threatening complications after esophageal stenting

ракпищеводстеноздисфагиястентированиерезультатосложненияcanceresophagusstenosisdysphagiaesophageal stentingoutcomescomplicationsReferencesСоколов В.В., Павлов П.В., Чиссов В.И. и др. Методы реканализации и стентирования при стенозирующем раке пищевода, желудка и 12-перстной кишки (Обзор литературы) // Сибирский онкологический журнал. - 2012. - №5(53). - С. 64-73Abadal JM, Echenagusia A, Simo G, et al. Treatment of malignant esophagorespiratory fistulas with covered stents. Abdom Imaging. 2001;26:565–569Abadal JM, Echenagusia A, Simo G, et al. Treatment of malignant esophagorespiratory fistulas with covered stents. Abdom Imaging. 2001;26:565–569Homann N., Noftz M.R., Klingenberg-Noftz R.D. et al. Delayed complications after placement of self-expanding stents in malignant esophageal obstruction: treatment strategies and survival rate. Dig Dis Sci 2008; 53: 2: 334-340Homann N., Noftz M.R., Klingenberg-Noftz R.D. et al. Delayed complications after placement of self-expanding stents in malignant esophageal obstruction: treatment strategies and survival rate. Dig Dis Sci 2008; 53: 2: 334-340Iwasaki H1, Mizushima T1, Suzuki Y1 et al. Factors That Affect Stent-Related Complications in Patients with Malignant Obstruction of the Esophagus or Gastric Cardia. Gut Liver. 2017 Jan 15;11(1):47-54Iwasaki H1, Mizushima T1, Suzuki Y1 et al. Factors That Affect Stent-Related Complications in Patients with Malignant Obstruction of the Esophagus or Gastric Cardia. Gut Liver. 2017 Jan 15;11(1):47-54Kujawski K., Stasiak M., Rysz J.: The evaluation of esophageal stenting complications in palliative treatment of dysphagia related to esophageal cancer. Med Sci Monit 2012; 18: 5: 323-329Kujawski K., Stasiak M., Rysz J.: The evaluation of esophageal stenting complications in palliative treatment of dysphagia related to esophageal cancer. Med Sci Monit 2012; 18: 5: 323-329Kun Yung Kim, Jiaywei Tsauo, Ho-Young Song et al. Self-Expandable Metallic Stent Placement for the of Esophageal Cancer. J Korean Med Sci. 2017 Jul;32(7):1062-1071Kun Yung Kim, Jiaywei Tsauo, Ho-Young Song et al. Self-Expandable Metallic Stent Placement for the of Esophageal Cancer. J Korean Med Sci. 2017 Jul;32(7):1062-1071Lai A1, Lipka S2, Kumar A3 et al. Role of Esophageal Metal Stents Placement and Combination Therapy in Inoperable Esophageal Carcinoma: A Systematic Review and Meta-analysis. Dig Dis Sci. 2018 Apr;63(4):1025-1034Lai A1, Lipka S2, Kumar A3 et al. Role of Esophageal Metal Stents Placement and Combination Therapy in Inoperable Esophageal Carcinoma: A Systematic Review and Meta-analysis. Dig Dis Sci. 2018 Apr;63(4):1025-1034Masaya Uesato, Yasunori Akutsu, Kentarou Murakami et al. Comparison of Efficacy of Self-Expandable Metallic Stent Placement in the Unresectable Esophageal Cancer Patients. Gastroenterol Res Pract. 2017; 2017: 2560510Masaya Uesato, Yasunori Akutsu, Kentarou Murakami et al. Comparison of Efficacy of Self-Expandable Metallic Stent Placement in the Unresectable Esophageal Cancer Patients. Gastroenterol Res Pract. 2017; 2017: 2560510Na HK, Song HY, Kim JH, et al. How to design the optimal self-expandable oesophageal metallic stents: 22 years of experience in 645 patients with malignant strictures. Eur Radiol 2013;23:786–796Na HK, Song HY, Kim JH, et al. How to design the optimal self-expandable oesophageal metallic stents: 22 years of experience in 645 patients with malignant strictures. Eur Radiol 2013;23:786–796Sarper A, Oz N, Cihangir C, et al. The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas. Eur J Cardiothorac Surg. 2003;23:794–798Sarper A, Oz N, Cihangir C, et al. The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas. Eur J Cardiothorac Surg. 2003;23:794–798Turkyilmaz A1, Eroglu A, Aydin Y et al. Complications of metallic stent placement in malignant esophageal stricture and their management. Surg Laparosc Endosc Percutan Tech. 2010 Feb;20(1):10-5Turkyilmaz A1, Eroglu A, Aydin Y et al. Complications of metallic stent placement in malignant esophageal stricture and their management. Surg Laparosc Endosc Percutan Tech. 2010 Feb;20(1):10-5Turkyilmaz A1, Eroglu A, Aydin Y et al. Complications of metallic stent placement in malignant esophageal stricture and their management. Surg Laparosc Endosc Percutan Tech. 2010 Feb;20(1):10-5

The authors declare that there are no conflicts of interest present.