覆膜支架置入治疗食管癌放疗后食管-气管（纵隔）瘘疗效及并发症探讨

Study on curative effect and complications of covered stent in the treatment of esophageal cancer esophageal-tracheal （mediastinal） fistula after radiotherapy

目的 探讨覆膜支架治疗食管癌放疗后食管-气管（纵隔）瘘疗效及并发症.方法 2008年8月至2013年7月我科收治250例食管癌放疗后食管-气管（纵隔）瘘患者,DSA引导下行覆膜支架置入治疗.结果 242例患者成功置入支架,复查食道造影瘘口均封闭,成功率96.8％.8例因患者难以耐受或术中出现大量呕血终止手术.所有支架均未取出.25例因再次出现瘘口而行第二次支架置入.所有病例术后均有异物感.10例出现明显胸痛,须应用第三阶梯止痛药.5例于2周至1月内出现食管大出血抢救无效死亡（2％）,KPS功能状态评分升高（P＜0.05）及KPS体力状态评分下降（P＜0.05）均有统计学意义.结论 覆膜食管支架治疗食管癌放疗后食管-气管（纵隔）瘘成功率高,明显改善患者生存质量.但必须严格掌握适应症,作好术前评估及准备,手术过程动作轻柔,减少并发症的发生.

Objective To explore the curative effect and complications of covered stent in the treatment of esophageal cancer esophageal-tracheal （mediastinal） fistula after radiotherapy.Methods From August 2008 to July 2013,our department treated 250 cases of esophageal cancer patients with esophageal -tracheal fistula （mediastinal） after radiotherapy by stenting treatment under DSA guiding.Results 242 patients were successfully placed with stents,with review of imaging of the esophagus fistula closed,the success rate was 96.8％.8 cases were terminated the operation because of difficulty to tolerate the process or occurring hematemesis during the operation.25 cases should be placed stents for the second time due to reappearring fistula.All cases had foreign body sensation.10 cases with obvious chest pain,must be applied in the third step of analgesic drugs.5 cases died from esophageal bleeding within 2 weeks to 1 month （2％）.Preoperative ~ function scores were higher than those postoperative （P ＜ 0.05） and KPS physical status scores decreased （P ＜ 0.05） statistically and significantly.Conclusion Covered stent in the treatment of esophageal cancer esophageal-tracheal （mediastinal） fistula after radiotherapy has high success rate,and could greatly improve the patients＇ quality of life.But it must be strictly grasping the indications,preoperative evaluation and preparation,soft and operation process,reducing the occurrence of complications.