Freeman Richard K, Ascioti Anthony J, Wozniak Thomas C
Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Ind, USA.
J Thorac Cardiovasc Surg. 2007 Feb;133(2):333-8. doi: 10.1016/j.jtcvs.2006.10.008. Epub 2007 Jan 2.
Leak after esophageal anastomosis or perforation repair prolongs hospitalization, prevents oral hydration and nutrition, and can produce localized infection or sepsis. This investigation reviews our experience treating postoperative esophageal leaks with the Polyflex esophageal stent (Boston Scientific, Natick, Mass).
Over a 30-month period, patients with a postoperative esophageal leak were treated with the Polyflex stent for leak occlusion. Leak occlusion was confirmed by means of esophagraphy. Patients were followed until their stent was removed and their esophageal leak had resolved.
Twenty-one patients had 27 stents placed for leak occlusion after esophagectomy (n = 5), esophageal perforation (n = 5), surgical (n = 4) or endoscopic (n = 2) antireflux procedure, and esophageal diverticulectomy (n = 3) or myotomy (n = 2). The mean interval between surgical intervention and stent placement was 12 +/- 8 days (range, 3-31 days). Occlusion of the leak occurred in 20 patients. One patient experienced a dehiscence of the surgical esophageal perforation repair requiring esophageal diversion. Stent migration requiring repositioning (n = 3) or replacement (n = 4) occurred in 5 (24%) patients. Twenty (95%) stents were removed without residual leak (mean, 51 +/- 43 days; range, 15-175 days). One patient had a stricture after stent removal that required endoscopic dilatation. One patient in this series died.
The Polyflex esophageal stent is an effective method for occluding a postoperative esophageal leak. It rapidly eliminates contamination of the mediastinum, pleura, and peritoneum; allows oral hydration and nutrition; and is easily removable. These stents also offer an appealing alternative to traditional esophageal diversion and subsequent reconstruction in patients with a persistent esophageal leak.
食管吻合口漏或穿孔修补术后的渗漏会延长住院时间，阻碍经口补液和营养摄入，并可导致局部感染或败血症。本研究回顾了我们使用Polyflex食管支架（波士顿科学公司，马萨诸塞州纳蒂克）治疗术后食管漏的经验。
在30个月的时间里，对术后食管漏患者使用Polyflex支架进行漏口封堵治疗。通过食管造影确认漏口封堵情况。对患者进行随访，直至支架取出且食管漏愈合。
21例患者在食管切除术后（n = 5）、食管穿孔（n = 5）、手术（n = 4）或内镜（n = 2）抗反流手术以及食管憩室切除术（n = 3）或肌切开术（n = 2）后放置了27个支架用于漏口封堵。手术干预与支架置入之间的平均间隔为12±8天（范围3 - 31天）。20例患者的漏口得以封堵。1例患者手术修补的食管穿孔发生裂开，需要进行食管转流术。5例（24%）患者发生支架移位，需要重新定位（n = 3）或更换（n = 4）。20个（95%）支架在无残余渗漏的情况下取出（平均51±43天；范围15 - 175天）。1例患者在支架取出后出现狭窄，需要进行内镜扩张。本系列中有1例患者死亡。
Polyflex食管支架是封堵术后食管漏的有效方法。它能迅速消除纵隔、胸膜和腹膜的污染；允许经口补液和营养摄入；并且易于取出。对于持续性食管漏的患者，这些支架也是传统食管转流术及后续重建术的一个有吸引力的替代方案。
