2)ステント留置術 (1)上部消化管 ① 食道―Self-Expandable Metallic Stent による治療

Self-Expandable Metallic Stents for Treatment of Malignant Esophageal Stenoses

要旨　Self-Expandable Metallic Stentは，留置が比較的容易で，少ない侵襲で高い治療効果が得られ，根治不可能な悪性食道狭窄の緩和治療として有用である．自験食道悪性狭窄例への留置92回の成功率は99％で，非切除・再燃胸部食道癌46例の留置では80％が粥以上摂食可能で35％が補助栄養なしに一度退院した．胸部食道留置の合併症は疼痛・穿孔・出血などだが頻度は低い．この他にもdislocation，ingrowthへの対応が必要となる．頸部食道や噴門にまたがって留置する場合の問題点，瘻孔や気道圧排への対応，他治療，特に放射線併用の注意など種々の問題点がある．安易な留置は避け，十分なインフォームドコンセントが必要である．

　Clinical results in treatment for malignant esophageal stenoses by placement of Self-Expandable Metallic Stents (SEMS) are excellent. Many patients with severe stenoses due to incurable esophageal cancer had undergone this treatment as a supportive treatment and they enjoyed improvement of dysphagia. It was effective in 99％ of 92 cases. In cases involuing 46 patients with unresectable cancers or recurrent tumors in the thoracic esophagus, 80％ of them could eat soft or normal meals after treatment and 35％ of all cases were discharged from hospital without supportive nutrition. Chest pain, rupture of the esophageal wall and bleeding from the tumor were complications of this treatment, although their incidence was low. At the same time, we must be aware of the possibility of dislocation of the stents and stenoses due to tumor ingrowth.

　We have to deal with frequent pain following stenting in the cervical esophagus, reflux due to stents across the cardia, esophageal fistula into the airway, dyspnea due to airway stenosis after treatment and unignorable dangers when stenting and other treatments, especially radiotherapy, are combined. Patients must be informed about risks and difficulties before the decision about the treatment can me made.