覆膜内支架在食管癌术后吻合口瘘中的应用

Clinical application of covered stent in the patients with anastomosis leakage after operation for esophageal cancer.

目的 :观察覆膜内支架在食管癌术后吻合口瘘中的应用效果。方法 :1 5例中、晚期食管癌术后 3～ 2 1天出现吻合口瘘。瘘口直径 0 .8～ 2 .1cm。将 1 80cm长交换导丝经口送入胃内 ,沿导丝送入支架输送系统 ,将直径 1 .8cm的双喇叭覆聚氨脂膜的镍钛记忆合金食管内支架的中点置于瘘口平面 ,透视下缓慢释放支架 ,后撤出输送系统和导丝。结果 :全部病例均一次放置成功 ,技术成功率为 1 0 0 %。 1 3例患者一次堵瘘成功 ,患者在支架置入术后 3～ 7天进半流质食物 ,1 5天后进普食 ,其余 2例病情改善。结论

Objective:To evaluate the clinical effect of covered stent in the patients with anastomosis leakage after operation for advanced esophageal cancer.Methods:15 patients were investigated.All of them were confirmed to be ill with advanced esophageal cancer by barium meal,endoscopy and pathology examination.The patients were underwent an esophagectomy(in 14 patients) and gastrectomy(in 1 patient).The reconstruction of the throat mucous membrane and anastomosis with the remaining esophagus(in 1 patient),esophageal gastric anastomosis(in 13 patients) and esophageal jejunum anastomosis(in 1 patient) were performed.The anastomosis leakage was detected on the 3rd to 21 postoperative day.The diameter of the leakage was measured in 0.8cm to 2.4cm.A covered stent was implanted by the means of peroral intubation under fluoroscopic guidaence.The body of stent was 18mm and the both end portions were 24mm in diameter.The middle segment of stent was placed at the level of the leakage.Results:All of the stents were successfully implanted without technical failure.The leakage was fully closed in 13 patients .The patients can have semi fluid food on the 3th to 7th postoperative day and full meal on the 15th day.The remaining 2 patients were significantly improved.Conclusion:Covered stent implantation is one of more effective means in the management of anastomosis leakage after operation for esophageal cancer.