覆膜自膨式金属支架治疗恶性食管气管瘘

Malignant esophagorespiratory fistulae treated with a covered Gianturco stent

目的 探讨覆膜金属支架治疗恶性食管气管瘘的效果及并发症。方法 在X线引导下 14例食管气管瘘用国产覆膜支架治疗 ,门诊行食管造影或电话随访。结果 除 1例瘘口封堵不全外 ,其余 13例瘘口完全封堵 ,未发生因操作引起的并发症。 8例进普食 ,6例进半流食 ,12例肺部感染得到控制。并发症 :严重胸痛 3例 ,支架移位致瘘再开放 1例 ,颈动脉及左侧喉返神经受压致头晕及咽麻痹各 1例。 8例病人死亡 ,术后生存时间 1 4～ 12个月 ,平均 4个月。 6例存活 ,术后随访时间 1 0～ 15个月 ,平均 6个月。结论 覆膜自膨式金属内支架治疗恶性食管气管瘘是有效的姑息性治疗手段 ,其操作简单 ,并发症少。

Objective To evaluate the therapeutic effects and complications of covered Gianturco stent for esophagorespiratory fistulae. Methods Under fluoroscopic guidance,14 patients with malignant esophagorespiratory fistulae were treated with silicone-covered modified Gianturco stent made in China. Follow-up with esophagography and communication was carried out. Results All but one fistulae were occluded. No immediate complications occurred. Eight patients could swallow all kinds of foods;six,soft foods. The 12 cases of inhalation pneumonia caused by the fistulae were recovered. Complications in the 14 patients included severe pain(n=3),reopened fistula caused by stent tube migration(n=1),left vocal cord paralysis(n=1) due to left recurrent laryngeal nerve compression by stent and dizziness(n=1) due to carotid artery compression by stent. 8 patients were dead with a mean survival of 4 months(range,14～12 months),and 6 patients were alive with a mean follow-up of 6 months(range,10～150 months). Conclusion The silicone-covered modified Gianturco stent is effective for palliation of esophagorespiratory fistilae. It is easy and safe to perform without remarkable complications.