Department of Surgery, The Methodist Hospital, Houston, Texas 77030, USA.
Ann Thorac Surg. 2010 Mar;89(3):931-6; discussion 936-7. doi: 10.1016/j.athoracsur.2009.10.061.
Esophageal or gastric leakage from anastomotic wound dehiscence, perforation, staple line dehiscence, or trauma can be a devastating event. Traditional therapy has often consisted of either surgical repair for rapidly diagnosed leaks or diversion for more complicated cases, commonly associated with a delayed diagnosis. This study summarizes our experience treating leaks or fistulas with novel, covered self-expanding metal stents (cSEMS). The primary objective of this study was to determine the efficacy and safety of covered self-expanding metal stents when used to treat complicated leaks and fistulas.
Over 15 months, 25 patients with esophageal or gastric leaks were evaluated for stenting as primary treatment. A prospective database was used to collect data. Stents were placed endoscopically, with contrast evaluation used for leak evaluation. Patients who did not improve clinically after stenting or whose leak could not be sealed underwent operative management.
During a mean follow-up of 15 months, 23 of the 25 patients with esophageal or gastric leaks during a 15-month period were managed with endoscopic stenting as primary treatment. Healing occurred in patients who were stented for anastomotic leakage after gastric bypass or sleeve gastrectomy (n = 10). One patient with three esophageal iatrogenic perforations healed with stenting. Eight patients successfully avoided esophageal diversion and healed with stenting and adjunctive therapy. Two of the 4 patients with tracheoesophageal fistulas sealed with the assistance of a new pexy technique to prevent stent migration; 1 additional patient had this same technique used to successfully heal an upper esophageal perforation.
Esophageal leaks and fistulas can be effectively managed with cSEMS as a primary modality. The potential benefits of esophageal stenting are healing without diversion or reconstruction and early return to an oral diet.
吻合口裂开、穿孔、吻合线裂开或创伤导致的食管或胃漏是一种破坏性事件。传统的治疗方法通常包括对快速诊断出的漏口进行手术修复，或对更复杂的病例进行引流，这些病例通常与延迟诊断有关。本研究总结了我们使用新型覆盖自膨式金属支架（cSEMS）治疗漏口或瘘管的经验。本研究的主要目的是确定覆盖自膨式金属支架在治疗复杂漏口和瘘管时的疗效和安全性。
在 15 个月的时间里，对 25 例食管或胃漏患者进行了支架置入治疗的评估。使用前瞻性数据库收集数据。支架通过内镜放置，使用对比剂评估漏口。对经支架治疗后临床状况未改善或漏口无法封闭的患者进行手术治疗。
在平均 15 个月的随访期间，在 15 个月期间，25 例食管或胃漏患者中有 23 例接受内镜支架置入作为主要治疗方法。胃旁路或袖状胃切除术后吻合口漏患者（n=10）经支架治疗后愈合。1 例因食管医源性穿孔的患者经支架治疗愈合。8 例患者成功避免食管转流并经支架置入和辅助治疗愈合。4 例气管食管瘘患者中有 2 例在新的套扎技术的帮助下成功封堵，以防止支架移位；另有 1 例患者使用相同的技术成功治愈了一个上段食管穿孔。
cSEMS 可作为一种主要治疗方法有效治疗食管漏和瘘。食管支架的潜在益处是无需转流或重建即可愈合，并能早期恢复口服饮食。
