Shin Ji Hoon, Song Ho-Young, Ko Gi-Young, Lim Jin-Oh, Yoon Hyun-Ki, Sung Kyu-Bo
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-ku, Seoul 138-736, Korea.
Radiology. 2004 Jul;232(1):252-9. doi: 10.1148/radiol.2321030733. Epub 2004 May 27.
To evaluate long-term clinical results of palliative treatment of esophagorespiratory fistulas (ERFs) with covered expandable metallic stents.
Sixty patients with ERFs due to esophageal or bronchogenic carcinoma and one patient with ERF due to pressure necrosis caused by initial esophageal stent placement for esophageal carcinoma were treated with covered expandable esophageal or tracheobronchial metallic stents. Information about technical success of stent placement, initial clinical success and failure, fistula reopening, and complications was obtained. Survival curves for both patient groups with initial clinical success and failure were obtained and compared with Kaplan-Meier methods and log-rank test.
Stent placement was technically successful in all patients, with no immediate procedural complications. The stent completely sealed off the fistula in 49 (80%) of 61 patients so that they had no further aspiration symptoms (initial clinical success). Twelve (20%) of 61 patients had persistent aspiration symptoms due to incomplete ERF closure (initial clinical failure). During follow-up, the fistula reopened in 17 (35%) of 49 patients with initial clinical success: In eight patients, the reopened ERF was sealed off successfully with stent placement or balloon dilation. In two patients with reopened ERF caused by food impaction, the reopened fistula resolved spontaneously. Seven patients did not undergo further treatment. All patients died during follow-up, and mean survival was 13.4 weeks (range, 1-56 weeks) after stent placement. Mean survival in patients with initial clinical success was significantly longer than that in patients with initial clinical failure (15.1 vs 6.2 weeks, P <.05).
Covered expandable metallic stents were placed in 61 patients with ERFs, but the initial clinical success rate was poor and the rate of reopening was high; however, interventional treatment was effective for sealing off reopened ERFs.
评估带膜可扩张金属支架姑息治疗食管气管瘘（ERF）的长期临床效果。
60例因食管癌或支气管源性癌导致ERF的患者以及1例因食管癌初次放置食管支架引起压迫性坏死导致ERF的患者接受了带膜可扩张食管或气管支气管金属支架治疗。获取了支架置入技术成功情况、初始临床成功与失败情况、瘘管重新开放情况及并发症等信息。采用Kaplan-Meier法和对数秩检验得出初始临床成功和失败的两组患者的生存曲线并进行比较。
所有患者支架置入技术均成功，无即刻手术并发症。61例患者中有49例（80%）支架完全封闭了瘘管，使其不再有呛咳症状（初始临床成功）。61例患者中有12例（20%）因ERF封闭不完全仍有持续呛咳症状（初始临床失败）。随访期间，49例初始临床成功的患者中有17例（35%）瘘管重新开放：8例患者通过再次置入支架或球囊扩张成功封闭了重新开放的ERF。2例因食物嵌塞导致ERF重新开放的患者，重新开放的瘘管自行愈合。7例患者未接受进一步治疗。所有患者在随访期间均死亡，支架置入后平均生存时间为13.4周（范围1 - 56周）。初始临床成功患者的平均生存时间显著长于初始临床失败患者（15.1周对6.2周，P <.05）。
61例ERF患者置入了带膜可扩张金属支架，但初始临床成功率低且重新开放率高；然而，介入治疗对封闭重新开放的ERF有效。
