不同类型被覆金属内支架治疗食管支气管瘘的初步研究

A preliminary study of tracheoesophageal fistula treated with different kinds of covered metallic stent

目的 :评价不同类型被覆金属内支架治疗食管气管瘘的临床效果。方法 :本组 10例 ,食管癌浸润或溃疡穿通所致食管气管瘘 6例 ,食管癌中段狭窄并网状金属内支架置入及放疗后致左支气管瘘 1例 ,BAI所致食管支气管瘘 3例。选用美国GianturcoZ型带膜支架 2例 ,Ultraflex支架 2例 ,国产带膜网状支架 6例。所有病例的支架置入均在透视下完成。结果 :10例支架置入术均 1次成功 ,瘘口完全封闭 ,饮水不再呛咳 ,术后第 2、3天全部能进半流质或软食 ,咳嗽、发热明显减轻 ,肺部感染多数得到有效控制。 1例内支架下滑 ,3例有返流性食管炎 ,1例支架上端再狭窄。随访 1～ 12个月 ,平均 6个月 ,2例食管大出血和 4例全身广泛转移于术后 6个月内死亡 ,4例术后行放、化疗者 ,生存期均超过 8个月 ,内支架通畅。结论 :应用不同类型被覆金属内支架治疗食管气管瘘是一种快捷易行、安全可靠的有效姑息治疗方法 ,术后配合放、化疗 ,能更好地延长生存期。

Objective:To evaluate different kinds of covered metallic stent implantation in treatment of tracheoesophageal fistula.Methods:10 cases of tracheoesophageal fistula including 6 cases caused by esophageal carcinoma,1 by stenting and radiotherapy for malignant esophageal stricture,and 3 by bronchial artery infusion(BAI).The stents used included Gianturco Z covered stent(n=2),Ultraflex stent(n=2) and home made Nitinol covered stent(n=6).10 covered stents were successfully implanted in all patients.Results:Stent implantation covered successfully and completely the fistula.The aphagia was greatly improved and the coughing due to drinking disappeared at once after the placement of the stents.All patients could take soft or semiliquid diet within 2～3 days.In most cases the infection of lung was effectively controlled.Complications of stenting included downward migration of stent(n=1),collapse of the upper end of stent(n=1) and gastroesophageal reflux(n=3). Patients were followed up 1～12 months (mean 6 months).2 patients with massive esophageal hemorrhage and 4 with extensive metastases died in 6 months.4 cases survived more than 8 months and received radiation and chemotherapy.Conclusion:Placement of covered stent is a simple,safe,effective and palliative treatment for tracheoesophageal fistula.