Clinical Application Study Of Fully Covered Segmental Esophageal Irradiation Stent

Part 1Fully covered segment esophageal irradiation stent:primary results of development and clinical applicationObject To investigate the feasibility of developing fully covered segment esophageal irradiation stent,and the safety and the curative effect of fully covered segment esophageal irradiation stent of clinical application.Methods The traditional esophageal stent was modified to fully covered segment esophageal irradiation stent,prescribed dose is 80Gy.We enrolled 12 patients with unresectable oesophageal cancer with dysphagia score of 3 or 4.The clinical effectiveness was observed after stents insertion.The follow-up contents included patients' situations,the location of 125I particles,the change of blood and immune index,the leakage of gamma rays and complications.Results Fully covered segment esophageal irradiation stent was developed successfully.The stents were put into the sites of 12 diseased esophagus,and was released without dropping off of the particles.The dysphagia score decreased(3.33 points vs 1.08 points,P=0.002)after stents insertion;The KPS score increased(55.00 points vs 62.50 points,P=0.007)one month after stent implantation.Blood and immune index showed no significantly statistically difference.Stent migration was discovered in one case.No radiated source leakage was discovered through the ECT examination.No serious complications such as upper gastrointestinal bleeding and tracheo-esophageal fistula was observed.Conclusion The clinical application of fully covered segment esophageal intraluminal irradiation stent was safe and feasible,it can relieve dysphagia and improve the quality of life effectively.Part 2Comparative analysis of Fully Covered Segmental Esophageal Irradiation Stent and in treatment of advanced esophageal carcinoma Object To investigate the differences of complications and clinical efficacy between fully covered segmental esophageal irradiation stent and conventional esophageal irradiation stent.Methods This was a retrospective study.Data were collected from 66 patients with esophageal cancer who had received the esophageal irradiation stent implantation in the department of Interventional and Vascular Surgery from 2013-09 to 2015-09 in Zhongda Hospital Affiliated to Southeast University.Patients were divided into two groups:fully covered segmented intraluminal irradiation esophageal stent group(the experimental group)and conventional esophageal intraluminal irradiation stent group(the control group).Postoperative complications,such as restenosis,migration and chest pain,and survival time were compared between two groups.A P value<0.05 was considered to indicate significantly statistically difference.Results The restenosis rates of the experimental group and the control group showed no significantly statistically difference(20.00%vs.30.56%,P=0.403).Compared with the control group,the experimental group had longer median restenosis time(161.5 days vs.138 days,P=0.025).However,the experimental group had a significantly higher stent migration rate than the control group(33.33%vs.8.33%,P=0.014).The median stent migration time of the two groups showed no significantly statistical difference(91.5days vs.166days,P=0.236).The survival time of the two groups also showed no significantly statistical difference(186days vs.178days,P=0.486).There were no significantly differences in other complications related to stent implantation between the two groups.Conclusion Fully covered segmental esophageal irradiation stent could delay the stent restenosis time,but increased the stent migration rate to a certain extent.