Hernandez Jonathan M, Barthel James S, Kelley Scott T
Department of Interdisciplinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa, Florida, USA.
Am Surg. 2008 Dec;74(12):1215-7.
Iatrogenic esophageal perforation during endoscopy in the setting of malignancy is an uncommon but often devastating complication and presents a formidable challenge to the surgeon. We sought to determine the efficacy of a self-expanding plastic stent for esophageal perforation before neoadjuvant chemoradiation in a single patient. A 74-year-old woman with a T4N0 adenocarcinoma at the gastroesophageal junction was perforated during upper endoscopy. We elected to manage the perforation with a silicone-covered, self-expanding Polyflex stent. Subsequent studies revealed good positioning of the stent with exclusion of the perforation from the esophageal lumen. The patient subsequently underwent neoadjuvant chemoradiation therapy with cisplatin, 5-flourouracil, and external beam radiation (2640 Gy) followed by minimally invasive, hand-assisted transhiatal esophagogastrectomy. We describe the first case of endoscopic stenting for locally advanced, perforated esophageal cancer for the purposes of administering neoadjuvant chemoradiation as a bridge to definitive surgery. This patient was able to resume oral nutrition after stenting and during neoadjuvant therapy, experiencing no major complications from chemoradiation. Chemoradiation does not necessarily preclude the use of endoscopically placed covered plastic esophageal stents as a bridge to resection, even in the face of iatrogenic perforation.
在内镜检查过程中，恶性肿瘤患者发生医源性食管穿孔是一种罕见但往往具有毁灭性的并发症，对外科医生构成了巨大挑战。我们试图确定自膨式塑料支架在单例患者新辅助放化疗前治疗食管穿孔的疗效。一名74岁女性，在胃食管交界处患有T4N0腺癌，在上消化道内镜检查时发生穿孔。我们选择用硅酮覆盖的自膨式Polyflex支架处理穿孔。随后的研究显示支架定位良好，穿孔被排除在食管腔外。该患者随后接受了顺铂、5-氟尿嘧啶新辅助放化疗及外照射（2640戈瑞），之后行微创、手辅助经裂孔食管胃切除术。我们描述了首例为实施新辅助放化疗作为确定性手术桥梁而对局部进展期穿孔性食管癌进行内镜支架置入的病例。该患者在支架置入后及新辅助治疗期间能够恢复经口营养，未出现放化疗的重大并发症。即使面对医源性穿孔，放化疗也不一定排除使用内镜放置的带膜塑料食管支架作为切除的桥梁。
