Özet:

Purpose: We intended to provide the effectiveness of self-expandible metal stents (SEMS) used in disphage and trakeo-ozofageal fistul palliation that occur in primary or secondary advanced tumors of the ozofagus, disphage score and fistul closure. Method: In our clinic between 1997-2002 is examined through 34 patient procedural records and patient files that were applied to stent due to ozofagus narrowness and/or fistulate cause. Patients were assessed by age, gender, stent application cause (the presence of rigidity and fistulate), narrowness or fistulate localization, pre- and post-operation disphagia scores (DS), used stent characteristics, the histopathology of tumors, advanced complications, whether or not there is need for restent. Results: In our clinic, 34 patients were applied 36 self-expandibl metal stents. The age range of patients was 44-82 and the average age was 64. 24 of the patients were male and 10 female. 15 of the patients considered inoperable (44 percent) were primary ozofagus cancer, 19 (56 percent) secondary ozofagus cancer. These secondary ozofagus carcinoms were distributed to 9 stomach, 8 lungs, 1 larenx cancer, 1 acute myeloid leukemia. The anatomical location of tumors was in the form of 1 (%3) cervical, 16 (%47) cervical and 17 (%50) distal ozofagus. In 25 patients (73.5%) there was narrowness, in 6 (17.6%) there was narrowness and fistule, in 3 (8.8%) there was only fistule. The 36 self-expandibl stent, which was applied to 34 patients for thinness and fistul palyation, was 30 ultra-lex (1 coverless, 29 covered), 3 wallstent, 3 wallstent, which was a modified form for gastro-özofageal compound tumors (Boston-Scientific). 5 of the 31 patients diagnosed with fatigue had fatigue (DS:4), 20 had difficulty eating liquid food (DS:3) and 6 had difficulty eating solid food (DS:2). These 31 patients with swallowing difficulties were diagnosed as 2.96 before the treatment, while 6 patients after the treatment had a minimum difficulty in swallowing solid food (DS:1), while the remaining 25 patients had a disphagia symptom completely disappeared (DS:0) and the average was DS:019. 9 (3 fistles, 6 fistles + thickness) of the patient's whole fistle tract, intended for the palliation of the fistle tract, was closed with self-expandibl metal stents. 36 stent applications for thirty-four patients did not detect major complications in patients, while the rate of minor complications was 17.6%. As a minor complication, migration in 2 patients, full obstruction in the distal end linked to the granulation tissue in 1 patient, and stentine in 1 patient was opened below 50%. Two of the patients with minor complications were restenting. Our stent rate was 5.8%. The result: SEMS is one of the first options in the palliation of malignity-related ozofagus and fistules. The development of ozofagus density and fistules associated with primary or secondary cancers with SEMS is a safe, effective, easily tolerable method for the patient. Safe placement of these stents in the right location can be achieved by the use of radiological floroscopy during application. Endoscopy before and after the process also improves the success and effectiveness of the process.

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