Wang Hongwu, Li Dongmei, Zhang Nan, Zou Hang, Luo Lingfei, Ma Hongming, Zhou Yunzhi, Li Jing, Liang Sujuan
Minimal Invasive Tumor Therapy Center, Meitan General Hospital, Beijing 100028, China.
Zhongguo Fei Ai Za Zhi. 2011 Aug;14(8):679-84. doi: 10.3779/j.issn.1009-3419.2011.08.08.
Treating airway fistulas, including esophagorespiratory fistulas (ERFs), bronchopleural fistulas (BPFs), and tracheomediastinal fistulas (TMFs), is difficult. The aim of this study is to evaluate the safety and clinical efficacy of metallic covered Z-type stents (CZTS) for the treatment of airway fistulas through bronchoscopy or fluroscopy.
Thirty-eight patients with fistulas between the esophagus, mediastina, and airways (32 ERFs, 5 BPFs, and 1 TMF) were retrospectively reviewed after treatment with covered metallic esophageal and airway stents. The fistulas were caused by esophageal (n=26), bronchogenic (n=11), and thyroid (n=1) carcinomas.
Forty-six fistulas were found in 38 patients. The fistula size ranged from 0.5 cm to 7.0 cm. Forty airway covered metal stents (24 Y-type, 8 L-type, and 8 I-type) and 24 esophageal metal stents were placed. Complete responses to the sealing effects of fistulas were noted in 4.3% of all the fistulas, 60.9% showed complete clinical responses, 23.9% showed partial responses, and 10.9% showed no response. An effectivity rate of 89.1% was observed, and the median survival duration of all patients was 5 months.
The use of CZTS appears to be safe and feasible for the palliative treatment of ERFs, BPFs, and TMFs. Airway stent placement is recommended for patients with ERF. In the event that airway stents fail, esophageal stents should be given. Airway bifurcation stents were observed to be especially suitable for the sealing of fistulas near the trachea carina.
治疗气道瘘，包括食管气管瘘（ERF）、支气管胸膜瘘（BPF）和气管纵隔瘘（TMF）很困难。本研究的目的是评估金属覆膜Z型支架（CZTS）通过支气管镜或荧光镜治疗气道瘘的安全性和临床疗效。
回顾性分析38例食管、纵隔与气道之间存在瘘管的患者（32例ERF、5例BPF和1例TMF），这些患者接受了覆膜金属食管和气道支架治疗。瘘管由食管癌（n = 26）、支气管源性癌（n = 11）和甲状腺癌（n = 1）引起。
38例患者共发现46处瘘管。瘘管大小为0.5厘米至7.0厘米。放置了40个气道覆膜金属支架（24个Y型、8个L型和8个I型）和24个食管金属支架。所有瘘管中4.3%对瘘管封闭效果完全缓解，60.9%显示完全临床缓解，23.9%显示部分缓解，10.9%无缓解。观察到有效率为89.1%，所有患者的中位生存时间为5个月。
CZTS用于ERF、BPF和TMF的姑息治疗似乎是安全可行的。建议对ERF患者放置气道支架。如果气道支架失败，应放置食管支架。观察到气道分叉支架特别适合封闭气管隆突附近的瘘管。
