硅酮支架治疗胸腔胃气道瘘的临床疗效观察研究  

The Observation Study of Airway Silicone Stent in the Treatment of Thoracogastric-Airway Fistula

作　　者：林连城 曾俊莉 柯明耀 陈钰沁 LIN Lian-cheng;ZENG Jun-li;KE Ming-yao;CHEN Yu-qin(Respiratory Hospital,the Second Affiliated Hospital of Xiamen Medical College,Fujian Xiamen 361021)

机构地区：[1]厦门医学院附属第二医院呼吸病院,福建厦门361021

出　　处：《中国医疗器械信息》2023年第14期1-4,34,共5页China Medical Device Information

摘　　要：目的:胸腔胃气道瘘是食管癌术后的严重并发症,治疗棘手。本研究旨在探索气道硅酮支架治疗胸腔胃气道瘘的近期临床疗效及安全性。方法:收集2017年10月~2022年2月的胸腔胃-气道瘘患者86例,根据瘘口位置、大小选择合适硅酮支架,在全麻硬镜下置入硅酮支架封堵瘘口。支架置入后评估封堵效果及支架相关并发症等。结果:86例胸腔胃气道瘘患者,共89个瘘口,置入硅酮支架91枚,其中5例患者置入双支架桥接封堵。所有支架均一次性成功放置,技术成功率100%。术后根据临床症状及碘水CT造影结果评估临床疗效:完全缓解49例(57.0%),未见造影剂渗漏,临床症状基本消失;部分缓解28例(32.6%),造影剂仍有少许渗漏,临床症状(饮水呛咳、咳痰等)明显减轻;无效9例(10.4%),造影剂渗漏明显,临床症状无明显减轻;总有效率为89.6%。中位生存时间为149d(95%CI:112.8~189.2)。主要并发症为痰液潴留、肉芽增生、咳嗽,并发症经内科药物及支气管镜下治疗后好转。结论:硬镜下置入气道硅酮支架治疗胸腔胃气道瘘可快速、有效、安全地封堵瘘口,患者的症状减轻、显著改善生活质量,并延长生存期。Objective:Thoracogastric-airway fistula is the life-threatening complication after esophagectomy for esophageal cancer.Management of this complication is still challenging.The aim of the study was to investigate the clinical efficacy and safety of airway silicone stent in the treatment of thoracogastric-airway fistula.Methods:We retrospectively analyzed 86 cases who suffered thoracogastric-airway fistula and received the placement of airway stent from October 2017 to February 2022.The appropriate silicone stent was selected according to the location,the size and the anatomical feature of the fistula.The clinical short-term efficacy and complications were evaluated.Results:86 patients with thoracogastric fistula had a total of 89 fistulas,and 91 silicone stents were placed.Among them,5 patients were placed with double stents for bridging and sealing.All stents were successfully placed at once,with a technical success rate of 100%.After surgery,clinical efficacy was evaluated based on clinical symptoms and iodine water CT imaging results:49 cases(57.0%)were completely relieved,no contrast agent leakage was observed,and clinical symptoms basically disappeared;Partial relief was observed in 28 cases(32.6%),with slight leakage of contrast agent and significant relief in clinical symptoms such as coughing and coughing due to drinking water;9 cases(10.4%)were ineffective,with significant leakage of contrast agent and no significant reduction in clinical symptoms;The total effective rate is 89.6%.The median survival time was 149 days(95%CI:112.8~189.2).The main complications were sputum retention,granulation hyperplasia and cough.The complications were improved after treatment with medical drugs and bronchoscopy.Conclusion:Placement of silicone stent could manage the thoracogastric-airway fistula effectively and safely.It may relieve the symptoms,improve the quality of life and prolong the survival time.

关 键 词：胸腔胃气道瘘 硬质支气管镜 硅酮支架 

分 类 号：R562.1[医药卫生—呼吸系统]