气道覆膜金属内支架介入治疗胸腔胃-气道瘘围术期处理  

Gastric-airway fistula: perioperative management of treatment with covered metallic stent

作　　者：石瑾[1] 韩新巍[1] 李永东[1] 吴刚[1] 邹治真[1] 

机构地区：[1]郑州大学第一附属医院放射科,郑州450052

出　　处：《中原医刊》2006年第20期20-22,共3页Central Plains Medical Journal

摘　　要：目的探讨覆膜金属内支架治疗胸腔胃-气管或支气管瘘的近期疗效和体会。方法搜集因胸腔胃-气管或支气管瘘接受自膨式覆膜内支架治疗的16例患者的临床资料。结果本组16例患者全部一次性成功地置入了气管或支气管封堵内支架，成功率100％。临床初步治愈12例，瘘口完全封堵，无对比剂溢入气道和肺部；临床初步失败4例，瘘口未完全封堵，仍有对比剂溢入气道和肺部。随访4～32个月，3例临床初步治愈者瘘口复发，其中2例接受了支架再置入治疗，1例仅置入胃肠减压管和空肠营养管。患者均于随访期间死亡，平均生存期（17±3）周。结论气道覆膜内支架封堵胸腔胃-气道瘘，操作简单，近期疗效肯定，但瘘口复发率较高，远期疗效有待进一步观察。Objective To evaluate nursing experience and short - term clinical results of palliative treatment of gastrotracheal fistulas （GTFs） or gastrobronchial fistulas （GBFs） with covered metallic stents. Methods Sixteen patients with GTFs or GBFs caused by irradiation or tumor recurrence after esophagogastrectomy due to esophageal carcinoma were treated with covered metallic stents. Significant leaks were revealed by a contrast - enhanced study at 2 - 25 months after surgery. Results Stent placement was technically successful in all patients, with no immediate procedural complications. The stent completely sealed off the fistula in 12 （75%） of 16 patients （ initial clinical success）, 4 （25 % ） of 16 patients had persistent aspiration symptoms due to incomplete GTF or GBF closure （ initial clinical failure）. During follow - up, the fistula reopened in 3 （25%） of 12 patients with initial clinical success. In 2 patients, the reopened GTF or GBF was sealed off successfully with stent placement, another patients with reopened fistula was only inserted gastrointestinal decompression tube and jejunal nutritive tube. All patients died during follow - up, and mean survival was （17 ± 3 ） weeks （range, 1 -42 weeks） after stent placement. Conclusion It is a sample, effective technique to seal off the GTFs or GBFs using covered metallic stent. The initial clinical success rate was acceptable and the rate of reopening was high. However, interventional treatment was effective for closure off reopened fistulas, and the mid - and - long term follow - up were needed.

关 键 词：食管癌 胃气管瘘 内支架 护理 

分 类 号：R735.1[医药卫生—肿瘤]