新型双盘状消化道瘘封堵器治疗10例难治性气管食管瘘的临床分析  

Clinical analysis of 10 cases of refractory tracheoesophageal fistula treated with novel double disc-shaped gastrointestinal occluder

作　　者：朱昌 李璐蓉 张伟锋[1] 桑怀鸣 叶强 王继旺 韦建宇 张国新[1] 王云[1] Zhu Chang;Li Lurong;Zhang Weifeng;Sang Huaiming;Ye Qiang;Wang Jiwang;Wei Jianyu;Zhang Guoxin;Wang yun(Department of Gastroenterology,the First Affiliated Hospital with Nanjing Medical University,Nanjing210029,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Micro-Tech(Nanjing)Co.,Ltd,Nanjing 210032,China)

机构地区：[1]南京医科大学第一附属医院消化内科,南京210029 [2]南京医科大学第一附属医院呼吸与危重症医学科,南京210029 [3]南微医学科技股份有限公司,南京210032

出　　处：《中华消化杂志》2022年第2期83-88,共6页Chinese Journal of Digestion

基　　金：江苏省研究生科研与实践创新计划(KYCX20-1404)。

摘　　要：目的评估本课题组发明的新型双盘状消化道瘘封堵器(以下简称封堵器)治疗难治性气管食管瘘(TEF)的安全性和临床疗效。方法收集2020年7月1日至2021年1月31日在南京医科大学第一附属医院消化内科接受封堵器治疗的10例难治性TEF患者。记录患者的临床资料如性别、年龄、体重指数、瘘口直径等,分析封堵器的手术成功率、术中和术后并发症、封堵时间、术后住院时间、瘘口封堵效果和术后恢复情况,比较患者术后1、3个月与术前的卡氏功能状态评分和体重指数以评估疗效。统计学方法采用配对t检验。结果10例TEF患者中,男7例,女3例,中位年龄(范围)为64.5岁(49.0~78.0岁),体重指数为(18.0±2.5)kg/m^(2),瘘口直径为(1.2±0.6)cm。所有患者均成功进行封堵器置入术,封堵时间(范围)为(17.6±7.8)min(7.0~30.0 min),术中有2例少量出血,术后无患者出血,术后住院时间(范围)为(5.9±4.0)d(1.0~12.0 d)。10例TEF患者中,5例瘘口完全封堵,4例部分封堵,1例无效封堵,封堵有效率为9/10。术后1个月随访显示,9例患者进食呛咳症状明显好转,1例患者经更换不同尺寸封堵器(腰部直径为12 mm更换为15 mm)后呛咳症状明显好转。术后3个月随访显示,8例患者封堵器在正确位置;1例患者出现封堵器移位,取出封堵器并予肠内营养支持治疗;1例患者因食管癌复发死亡。10例TEF患者术后3个月的卡氏功能状态评分和1、3个月的体重指数均高于术前[(70.0±34.0)分比(46.0±10.7)分,(19.32±2.59)、(19.73±2.92)kg/m^(2)比(18.03±2.50)kg/m^(2)],差异均有统计学意义(t=-3.09、-2.37、-2.82,均P<0.05)。结论临床应用封堵器治疗难治性TEF是安全、有效的。Objective To evaluate the safety and clinical efficacy of the novel double disc-shaped gastrointestinal occluder(hereinafter referred to as occluder)in treatment of refractory tracheoesophageal fistula(TEF).Methods From July 1,2020 to January 31,2021,10 patients with refractory TEF treated with occluder at Department of Gastroenterology,the First Affiliated Hospital with Nanjing Medical University were collected.The patients′clinical data such as gender,age,body mass index and fistula diameter were recorded.The success rate of operation,intraoperative and postoperative complications,operation time,postoperative hospital stay,efficacy of fistula closure and postoperative recovery were analyzed.The Karnofsky score and body mass index of patients 1 month and 3 months after operation were compared with those before operation for curative effect evaluation.Paired t test was used for statistical analysis.Results Among the 10 TEF patients,there were 7 males and 3 females,the median age was 64.5 years old(ranged from 49.0 to 78.0 years old),the body mass index was(18.0±2.5)kg/m^(2) and the diameter of the fistula was(1.2±0.6)cm.Occluder placement was successful in all patients.The operation time was(17.6±7.8)min(ranged from 7.0 to 30.0 min).Two cases had little bleeding during the operation,and there was no bleeding after the operation.The postoperative hospital stay was(5.9±4.0)d(ranged from 1.0 to 12.0 d).Among the 10 TEF patients,fistula of 5 patients were completely blocked,4 cases were partially blocked and 1 case was ineffectively blocked,the effective rate of blocking was 9/10.One month follow-up after operation showed that the symptoms of choking and coughing during eating were significantly improved in 9 patients,and the symptoms of choking and coughing during eating were significantly improved in 1 patient after waist diameter of 12 mm occluder was replaced with the occluder of 15 mm.The 3-month follow-up after operation showed that the occluders were in the right place in 8 patients,the occluder was disp

关 键 词：气管食管瘘 新发明 消化道瘘封堵器 内镜治疗 

分 类 号：R655[医药卫生—外科学]