组合式Y型覆膜金属支架在复杂胸腔胃-气道瘘中的应用

The Integrated Place of Y-shaped Self-Expandable Coveredmetal Stents(Y-shaped SECMS) in the Management of Complex Thoracostomach-Airway Fistula:a Clinical Analysis of 10 Cases

目的探讨组合式Y型一体化自膨式覆膜金属支架（Y-shaped SECMS）治疗复杂胸腔胃-气道瘘的安全性和疗效。方法回顾性分析10例复杂胸腔胃-气道瘘（4例胸腔胃-隆突及左主支气管瘘,4例胸腔胃-隆突及右主支气管瘘,2例胸腔胃-隆突巨大瘘）患者的临床及影像学资料,根据瘘口的位置、大小、相关气道直径,个体化设计2~3枚Y-shaped SECMS（跨越隆突区域放置的称大Y支架,跨越叶支气管分叉处放置的称小Y支架）。在X线透视下,先行患侧气道内小Y型支架置入,造影证实无误后于气管隆突处行大Y支架置入,确保大Y支架的分支部与小Y支架的主体部部分重叠。结果所有患者组合式Y-shaped SECMS均一次性置入成功,术中即刻气道和食管造影均未见对比剂进入对侧,瘘口封堵完全;术后患者进食顺畅,无呛咳,生活质量提高。患者术后均获得完整随访,6例患者分别于术后3.2~8个月死亡,死因分别为晚期肿瘤消耗（4例）、咯血（1例）和肺部感染（1例）;1例患者术后4个月出现隆突区瘘口增大,再次给予一枚小Y支架置入并证实瘘口封堵完全并存活;余3例患者存活,生活质量满意。结论组合式Y-shaped SECMS置入能有效封堵复杂胸腔胃-气道瘘,技术可行,近期疗效可靠。

Objective To investigate the clinical feasibility and efficacy of integreted Y shaped SECMS in the management of complex thoracostomach airway fistula.Methods Retrospective analysis of ten patients treated for thoracostomach airway fistula with integrated Y-shaped SECMS.Y-shaped SECMSwere designed based on the dimensions of trachea and bronchus and sites of the fistula and then were inserted to carina and main bronchus under DSA monitoring.Results Stent implantation was successfully accomplished with single manipulation in all ten patients,complete occlusion of the fistula was obtained in all patient.The patients were followed up for 2-15 months.Six patient died of tumor consumption,hemoptysis,pulmonary infection,respectively.One patient inserted the third stent for the treatment of fistula enlarged.Other three patients are still alive and living quality were much improved.Conclusion The placement of integreted Yshaped SECMS can completely obstruct the complex thoracostomach airway fistula.The technique is feasible with reliable short term effect.