恶性肿瘤性食管瘘的内镜治疗  

Endoscopic treatment of malignant esophageal fistulae

作　　者：潘峰[1] 马士杰[1] 李倩君[1] 冯亚东[2] 周传文[1] 

机构地区：[1]南京医科大学附属淮安第一医院外科,淮安223300 [2]南京医科大学第一附属医院消化科

出　　处：《消化肿瘤杂志（电子版）》2013年第1期52-55,共4页Journal of Digestive Oncology(Electronic Version)

基　　金：国家自然科学基金(30770992)

摘　　要：目的探讨不同类型恶性肿瘤性食管瘘的治疗方法和效果。方法共29例恶性肿瘤食管瘘患者,包括食管癌并穿孔9例,食管癌术后吻合口瘘8例,食管癌新辅助放化疗后食管瘘12例,根据瘘的不同选择不同的治疗措施。观察不同治疗方法的可行性和治疗效果。结果 21例食管支气管瘘患者中,14例行食管支架置入,2例气管支架置入,5例因瘘口较小仅行空肠营养管置入和胃肠减压。5例食管纵隔瘘患者行内镜下瘘口置管引流及肠内营养管置放。3例食管胸腔瘘患者行空肠营养管置放及胸腔闭式引流。所有患者均成功进行内镜下治疗,术中无严重并发症发生。27例患者病情得到缓解,生活质量明显提高,2例患者因术后出现严重并发症死亡。结论内镜下治疗恶性食管瘘具有技术可行、创伤小、疗效好的特点。对不同的恶性食管瘘患者,需要根据瘘的具体情况采取不同的治疗方法。Objectives To investigate the feasibility and effect of endoscopic treatment of malignant esophageal fistulae. Methods A total of 29 patients with different malignant esophageal fistulas who underwent different endoscopic treatment methods were retrospectively analyzed. The feasibility,efficacy and safety of different treatment methods were evaluated. Results Among 21 esophgotracheal fistula patients, esophageal stent implantation was performed in 14, tracheal stent implantation in 2, and only jejunal nutritional tube placement and gastrointestinal decompression were performed in 5 patients with small fistula. Five esophgomediastinal fistula patients underwent endoscopic drainage tube within the fistula and nutritional tube placement. Three esophageal thoracic cavity fistula patients underwent nutritional tube placement and closed drainage of pleural cavity. All patients with fistula underwent endoscopic treatment without severe complications. After treatment,27 patients recovered soon with improved nutrition and quality of life,2 patients died due to severe postoperative complications.Conclusions Endoscopic treatment is feasible and effective in treatment of malignant esophageal fistulae.Different treatment methods should be performed according to different types of fistula and fistula size.

关 键 词：食管癌 瘘 内镜治疗 

分 类 号：R735.1[医药卫生—肿瘤]