Colt H G, Meric B, Dumon J F
Centre Laser et Service d'Endoscopie Thoracique du CHU Sud, Hôpital St. Marguerite, Marseille, France.
Gastrointest Endosc. 1992 Jul-Aug;38(4):485-9. doi: 10.1016/s0016-5107(92)70482-9.
Extrinsic compression, neoplastic involvement of the trachea or left main bronchus, and esophago-airway fistula may cause airway obstruction and infection in patients with esophageal carcinoma. Further reduction of airway lumen may result from palliative treatment of dysphagia by radiation or esophageal stent insertion. In order to evaluate the extent of airway compromise, bronchoscopy was systematically performed in 39 consecutive patients with advanced carcinoma of the esophagus requiring esophageal endoprostheses. Airway obstruction observed in 10 patients (mean age, 60 years) resulted in the additional placement of a silicone stent in the trachea (five patients) or left main bronchus (five patients). Esophageal and airway procedures were performed under general anesthesia. All had squamous cell carcinoma of the middle third of the esophagus. Severe dyspnea at rest was documented in five patients prior to intervention. Esophago-tracheal fistula was present in five. Eight patients with associated, neoplastic invasion of the tracheo-bronchial tree required airway Nd:YAG laser therapy. The esophageal prosthesis contributed significantly to airway compromise in four patients. Symptomatic relief of dysphagia and dyspnea was obtained in all individuals. Mean survival was 121 days (range, 12 to 350 days). Complications were not serious, but included esophageal or tracheal stent migration in three patients.
外在压迫、气管或左主支气管的肿瘤累及以及食管气道瘘可导致食管癌患者气道阻塞和感染。吞咽困难的姑息性放疗或食管支架置入治疗可能会进一步导致气道管腔变窄。为评估气道受影响的程度，对39例连续的晚期食管癌患者进行了系统的支气管镜检查，这些患者均需要置入食管内支架。10例患者（平均年龄60岁）出现气道阻塞，其中5例在气管、5例在左主支气管额外置入了硅酮支架。食管和气道手术均在全身麻醉下进行。所有患者均为食管中段鳞状细胞癌。干预前，5例患者静息时出现严重呼吸困难。5例存在食管气管瘘。8例伴有气管支气管树肿瘤侵犯的患者需要气道钕钇铝石榴石激光治疗。4例患者的食管支架对气道造成了明显影响。所有患者的吞咽困难和呼吸困难症状均得到缓解。平均生存期为121天（范围12至350天）。并发症并不严重，但3例患者出现了食管或气管支架移位。
