覆膜内支架治疗食管-气管瘘的疗效观察

摘要

Objective To explore the methods and curative effect of covered metallic self-expanding stent in esophageal cancer with esophagotracheal fistula. Methods Under fluoroscopic guidance, home-mode covered metallic self-expanding stents were placed in 15 patients with esophagotracheal fistulas after radiotherapy and in 4 patients with anastomotic recurrence after radical resection of esophageal carcinoma accompanied by esophagobronchial fistulas. Patients were given anti-inflammatory, bleeding, pain treatment after stent placement. Results 18 cases were treated successfully at one time. Stent migration occurred in 1 case during treatment, and the second stent was implanted in time. All cases were complete occlusion fistula. The intraoperative adverse events included small amount of bleeding occurred in 11 cases.Postoperative adverse events included 15 cases required pain medication, 2 cases had a small amount of hematemesis, melena in 3 cases, 2 cases had a large haematemesis died, 1 case had stent obstruction by food, 2 cases of tumor growth blocked stent. In the follow-up period, 14 patients died. The main death reasons were lung infection and system exhaustion. Conclusion Using covered metallic self-expanding stent for treatment of esophageal carcinoma with esophagobronchial fistulas is an effective palliative treatment, which can improve the quality of life of patients.%目的 探讨覆膜内支架治疗食管癌并发食管一气管瘘的方法和疗效.方法 在X线引导下对15例食管癌放疗后导致食管-气管瘘、4例食管癌术后吻合口复发导致食管-气管瘘患者行国产覆膜内支架置入治疗,术后给予抗炎、止血及止痛治疗.结果 18例一次性操作成功,1例术中支架向下移位并及时补放第二枚支架,11例出现术中少量出血,所有病例的瘘口均完全封堵;术后有15例需药物止痛,2例出现少量呕血,3例出现解黑便,2例出现大呕血死亡,1例出现食团阻塞支架.2例出现肿瘤生长阻塞支架;随访期内死亡14例,死亡原因为肺部感染和全身衰竭.结论 采用覆膜内支架置入治疗食管癌并发食管-气管瘘是一种可提高患者生存质量有效的姑息性治疗方法.