经胃造口逆向植入支架治疗食管癌性狭窄和瘘2例报道

Reverse Placing into the Stent to Treat the Esophageal Structure and Fistula through with Gastrostomy:2 Cases Report

目的探讨经过胃手术造口途径逆向置放食管支架治疗食管瘘的可行性。方法使用手术腹壁胃造口途径经由贲门至食管逆向操作,反向置入食管被膜支架以治疗食管癌性狭窄和瘘。结果二例晚期食管癌患者因食管严重狭窄迂曲,引导钢丝不能经口顺向通过病变段,导致采用常规方法无法置放食管支架;后改经手术胃造口途径逆向植入食管被膜支架均获得成功,食管瘘口被完全封堵,食管狭窄解除,恢复经口进食。其中一例因高龄及原先吸入性肺炎无法控制终至呼吸衰竭而死亡,另一例存活一年后因癌转移而死亡。结论经手术胃造口逆向植入食管支架方式治疗复杂食管癌性狭窄和瘘切实可行,但需要积极尽早实施方能收到最佳疗效。

Objective： To investigate the feasibility of placing the esophageal stent with a cover to cure the esophageal stricture and fistula backward through with gastrostomy. Methods： The esophageal stent be placed to the esophagus reversely via cardia through gastrostomy. Result： Two cases with advanced cancer of esophagus were involved in this report. Their esophageal lesion is very complicated and curver and so a guiding wire can not be put into the narrowed canal of esophagus through the mouth. Therefore, it is failed to putting the stent into the esophagus with routine way. But we had successed to complete this process by reverse operation through a gastrostomy. As a result, their esophageal fistulas were covered and the cancerous strictures were released as well as ingesting food by mouth were recovered. First case died because his advanced age and the aspiration pneumonitis before our performance had no way to control until breath failure. Another case was survival beyond one year and died because of cancer metastasis. Conclusion： It is feasibility to reverse implantation of the esophagus stent through with gastrostomy for curing the narrow of complicated cancer of the esophagus with fistula, but this operation must be carried out as early as possible so as to obtain the best curative effect.