透视下植入带膜记忆金属支架治疗恶性气管食管瘘  

Deployment of self-expanding membranous metallic stents under fluoroscopic guidance in patients with malignant esophagorespiratory fistulae:a report of 6 patients

作　　者：陈佶[1] 陈志明[1] 庞烈文[1] 朱勇俊[1] 陈刚[1] 马勤运[1] 苗锋[1] 

机构地区：[1]复旦大学附属华山医院胸外科,上海200040

出　　处：《复旦学报（医学版）》2010年第4期468-471,共4页Fudan University Journal of Medical Sciences

摘　　要：目的评价单纯透视下置放带膜自扩记忆金属支架治疗恶性气管食管瘘(esophagorespiratory fistulae,ERF)的临床疗效及其安全性。方法回顾性收集6例恶性ERF单纯透视下接受带膜自扩记忆金属支架治疗的患者资料,比较治疗前后吞咽困难指数和Karnofsky评分,并进行治疗后随访。结果6例ERF患者中,4例为食管癌,1例为肺癌纵隔淋巴结转移,1例为气管肿瘤。所有患者均成功地在单纯透视下置入带膜自扩记忆金属支架,无操作相关并发症。支架置入后平均吞咽困难指数为1.17±0.75,Karnofsky评分改善明显。随访显示5位已死亡患者治疗后平均生存151.6天,另1例随访中已存活84天。结论单纯透视下置放带膜记忆金属支架治疗恶性ERF患者安全可靠,治疗后有助于改善ERF患者的生存质量。Objective To evaluate the placement of self-expanding metallic stents under fluoroscopic guidance without the use of endoscopy in 6 terminally-ill patients with malignant esophagorespiratory fistulae（ERF）. Methods We undertook a retrospective review of 6 patients who had undergone the placement of self-expanding metallic stents for palliation of esophageal respiratory fistulae using only fluoroscopy for guidance.The main outcome measurements were dysphagia scores,Karnofsky performance scores,and overall survival scores. Results A review of our records revealed that in the 6 patients,4 were caused by esophageal cancer and 2 were caused by bronchogenic or tracheal carcinoma.Six stents were inserted into the 6 patients using only fluoroscopy for guidance without technical failure or complications.The mean dysphagia score was 1.17±0.75,and Karnofsky performance status improved significantly.After the procedure,pneumonia resolved completely in all but one patient.Five patients died after a mean survival period of 151.6 days.Recurrent dysphagia in one patient caused by tumor overgrowth 10 months after stent placement was successfully alleviated by electrocautery. Conclusions Our case series of 6 patients with ERF undergoing self-expanding metallic stent placement provides evidence that these procedures can be performed safely and quickly under radiologic guidance alone.

关 键 词：支架 恶性气管食管瘘 透视 

分 类 号：R655.4[医药卫生—外科学]