DSA定位下不同原因食管气管瘘内支架置入的临床应用

Application of stent implantation for treatment of esophagotracheal fistula caused by different disorders under the DSA

目的探讨内支架置入在不同原因食管气管瘘中的应用,总结支架处理的手术难点和临床疗效。方法 12例经碘水造影确诊食管气管瘘患者,其中食管癌术后吻合口瘘6例,选择两端球头直径至少大于体部6 mm的支架;食管支架置入后瘘2例,采用咳嗽动态显影和导丝的应用确认瘘口位置;放疗后瘘4例均先使用球囊导管预扩张。在数字减影血管造影(DSA)下准确定位后行支架置入。结果 11例支架置入成功,瘘口完全封堵,肺部感染得以控制,术中无并发症,其中1例支架置入后15 d出现大出血死亡;另外1例置入支架后瘘口仍存在,1个月后死于肺部感染。结论对于不同原因食管气管瘘患者,关键是选择合适类型和直径的支架,同时支架置入后疗效确切,并发症少。

Objective To evaluate the operation difficulty and clinical effect of placement of stent in treating esophagotracheal fistula due to different causes.Methods Twelve patients with esophagotracheal fistula were confirmed by iodine solution radiography.Anastomotic fistula after resection of esophageal carcinoma was in 6 cases,who selected both ends of the stent diameter at least 6 mm more than the body;in 2 cases of esophageal stent fistula,cough dynamic developing and guide wire were applied to confirm the fistula position;4 cases after ra-diotherapy fistula were the first to use balloon catheter dilation.The stent was accurately implanted into the esophagotracheal fistula under DSA.Results The stent implantation was successful in 1 1 patients and no related complications happened.The fistula was completely closed and the inspiration pneumonia caused by fistula was under control.Among them 1 case died of bleeding 15 d after stent placement;fistula still existed in another 1 case after stenting,who died of pulmonary infection 1 month later.Conclusion Stent placement is an effective method with less complications for treatment of esophagotracheal fistula caused by different disorders,and the key is to choose the right type and di-ameter of stent.