Y 型硅酮气管支架置入治疗恶性气管食管瘘临床体会并文献复习

Experience and literature review of Y-type silicone tracheal stent in management of malignant tracheoesophageal fistula

目的：探讨 Y 型硅酮支架置入方法技巧及气管食管瘘（TEF）封堵的相关临床问题。方法复习我院 Y 型 Dumon 支架置入病例，分析操作准备、气管食管瘘封堵疗效及相关注意问题。结果确定气管支架直径[（横径＋纵径）/2]并适形裁剪、打磨，硬质支气管镜下高频通气，支架由推送器经硬镜释放，配合可弯曲支气管镜，可成功置入，术后雾化吸入和随访复查，瘘口封堵良好，未见并发症。结论 Y 型 Dumon 支架对于隆突周围 TEF 疗效肯定、安全。充分病情评估、仔细测量瘘口大小，选择合适直径、医护密切配合是 Y 型硅酮支架置入重要环节，加强术后随访管理可一定程度上预防并发症。

Objective To investigate the placement technique of Y-type silicone stent and related issue of tracheoesophageal fistula（TEF）treatment.Methods To review the case with TEF treated by Y-type Dumon stent in our hospital,the preparation for procedure,the effect and the related issues of Y-type Dumon stent for TEF was summarized.Results Diameter of the tracheal and TEF was measured according to CT and the diameter of Y-type Dumon stent（transverse diameter＋longitudinal diameter/2） was decided.Then the grinded Y-type Dumon stent was placed to the appropriate position by pushing device through rigid bronchoscopy during high frequency ventilation.Flexible bronchoscopy was used to help adjust the position of stent.No complication was found.After procedure,long term follow-up with bronchoscope and inhalation of normal saline with or without some expectorants was recommended. Conclusions TEF located around carina treated with Y-type Dumon stent is effective and safe.To assess the diseases carefully with a good work team and select an appropriate size of stent are all essential factors for successful Y-type silicone stent placement.The follow-up and management of airway after procedure are also very important for preventing the complications.