胃造瘘术与食管支架植入术对危重症气管食管瘘患者的疗效评估

Effects of self-expandable metallic stents and percutaneous endoscopic gastrostomy in the treatment of tracheoesophageal fistulas

目的评估内镜下食管覆膜自膨式金属支架植入术与经皮内镜下胃造瘘术(PEG)在气管食管瘘治疗中的应用价值。方法19例良性气管食管瘘患者,9例行PEG留置造瘘管、10例行内镜下食管覆膜自膨式金属支架植入术,2个月后经内镜将金属支架取出,以吞咽—咳嗽征检测气管食管瘘是否完全愈合。结果两组患者肺部感染的治愈率与治疗失败率方面差异无显著性,但PEG留置胃造瘘管组患者气管食管瘘黏膜的愈合率显著高于行内镜下食管覆膜自膨式金属支架植入术患者(P<0.05)。结论经PEG留置胃造瘘管对于治疗气管食管瘘显著优于行内镜下食管自膨式覆膜金属支架植入术。

Objective To assess the effects of self-expandable metallic stents （covered-SEMS） and percutaneous endoscopic gastrostomy （PEG） in the treatment of tracheoesophageal fistulas. Methods In 19 patients with nonmalignant tracheoesophageal fistulas in intensive care unit, 9 patients accepted PEG tubes inserted by push technique. The remaining 10 patients accepted the insert of self-expandable metallic stents and the stents were extracted 2 months later with the complete mucosal healing confirmed by endoscopy and typical swallow-cough sign. Results There was no significantly difference in the pulmonary infection recovery rate between the two groups, nor in adverse event rates. The recovery rate of tra- cheoesophageal fistulas in PEG-tube patients was significantly higher than that of covered-SEMS patients （ P 〈 0.05 ）. Conclusion PEG tube maybe superior than covered-SEMS to treat intensive tracheoesophageal fistulas patients.