食管支架置入是治疗良恶性食管狭窄及食管瘘、快速恢复经口进食的重要微创手段,其中自膨式金属支架应用最为广泛。然而,支架移位仍是影响治疗效果和患者预后的主要并发症之一,可导致吞咽困难复发、瘘口再开放、消化道梗阻甚至组织损伤。本文围绕食管支架移位的危险因素及抗移位策略进行综述。研究表明,支架移位与支架结构特征、覆膜类型、直径和长度、置入部位、狭窄程度、食管动力学特征以及放化疗等多种因素密切相关。其中,全覆膜支架、较小直径支架、跨胃食管交界部置入及放化疗后肿瘤缩小均会增加移位风险。为降低移位发生率,已出现支架凸起、双层网格结构、分节段、个体化3D打印等多种支架设计方案,这些方案通过增强机械锚定、提高组织贴合度或增加界面摩擦力来改善稳定性。与此同时,挂线外固定、内镜缝合、金属夹具夹闭等方法,可减少高风险患者的支架移位,但仍存在操作复杂、成本较高或长期固定效果有限等问题。总体而言,现有抗移位措施虽能在一定程度上降低支架迁移发生率,但尚难完全避免。未来应结合材料科学、生物工程、3D打印及智能制造等多学科技术,开发兼具良好生物相容性、个体化适配性和长期稳定性的食管支架,并通过高质量前瞻性临床研究验证其安全性与有效性,从而进一步提高食管支架治疗的临床获益。
Abstract
Esophageal stent placement is a minimally invasive and effective intervention for the management of benign and malignant esophageal strictures and esophageal fistulas, facilitating the rapid restoration of oral intake. Among the available devices, self-expanding metal stents are the most widely used. However, stent migration remains one of the most common complications, significantly compromising therapeutic efficacy and patient outcomes. Migration may result in recurrent dysphagia, fistula reopening, gastrointestinal obstruction, and even tissue injury. This review summarizes the risk factors associated with esophageal stent migration and recent advances in anti-migration strategies. Current evidence indicates that migration is influenced by multiple factors, including stent structural characteristics, covering type, diameter and length, deployment location, severity of stricture, esophageal motility, and chemoradiotherapy. In particular, fully covered stents, smaller stent diameters, placement across the gastroesophageal junction, and tumor regression following chemoradiotherapy are associated with an increased risk of migration. To reduce migration, various anti-migration stent designs have been developed, including stents with fins, circumferential protuberances, double-layer mesh structures, segmented stents, patient-specific three-dimensional (3D)-printed stents, and bioadhesive coatings. These approaches aim to improve stent stability through enhanced mechanical anchorage, better tissue conformity, or increased interface friction. In addition, fixation techniques such as external traction fixation, endoscopic suturing, over-the-scope clips, and through-the-scope clips have been employed to reduce migration in high-risk patients. Nevertheless, these methods remain limited by procedural complexity, cost, and variable long-term efficacy. Although current anti-migration strategies can reduce the incidence of stent migration to some extent, complete prevention remains challenging. Future developments should integrate advances in materials science, bioengineering, 3D printing, and intelligent manufacturing to develop esophageal stents with improved biocompatibility, individualized adaptability, and long-term stability. Furthermore, high-quality prospective clinical studies are required to validate their safety and efficacy and to optimize the clinical benefits of esophageal stent therapy.
关键词
食管支架 /
移位 /
危险因素 /
抗移位设计 /
支架固定技术 /
内镜缝合 /
生物黏附材料 /
3D打印
Key words
Esophageal stent /
Migration /
Risk factors /
Anti-migration design /
Stent fixation techniques /
Endoscopic suturing /
Bioadhesive materials /
Three-dimensional (3D) printing
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基金
福建省科技创新联合资金项目(2023Y9250);泉州市高层次人才团队项目(2024CT014)
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