食管胸腔胃吻合口内支架并发食管气管瘘的内支架再置入治疗

Re-stenting treatment for esophagotracheal fistula caused by intrathoracic gastroesophageal anastomosis stent

目的探讨食管癌术后食管胸腔胃吻合口狭窄行支架置入后形成食管-气管瘘,再次采取支架置入治疗的疗效。方法 6例食管胸腔胃吻合口狭窄支架置入后并发食管气管瘘。X线监视下,取出原食管支架,再次置入1枚较长的食管覆膜支架,消除食管与支架成角现象。结果本组原支架取出顺利,未出现严重并发症。均再次置入较原支架长20～40mm的支架,支架置入后均出现不同程度咽部疼痛不适,患者能够耐受,进食顺利。结论食管胃吻合口狭窄支架置入后并发食管-气管瘘,可以置换稍长支架进行补救。

Objective To evaluate the curative effect of stent replacement for the treatment of esophagotracheal fistula which occurred after the stent implantation for stenosis of intrathoracic gastroesophageal anastomotic stoma.Methods Six patients with esophagotracheal fistula occurred after stent placement for stenosis of intrathoracic gastroesophageal anastomotic stoma were enrolled in this study.Under X-ray monitoring,the previous stent was taken out and a new,longer,covered stent was inserted into the esophagus in such a way that the stent would not be angled with the esophagus.Results The previous stent was successfully taken out in all patients.No serious complications such as esophageal rupture,mediastinal abscess,hemorrhage,apnea or dyspnea occurred.The replacement of the covered stent,which was 20 40 mm longer than the previous one,was also successfully performed.All the patients complained different degrees of,but tolerable,pharyngeal pain after the stenting procedure,however,the pain was markedly relieved after symptomatic treatment.Conclusion Esophagotracheal fistula occurred after the stent implantation for stenosis of intrathoracic gastroesophageal anastomotic stoma can be effectively treated by replacing a longer covered stent.