Department of General and Visceral Surgery, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany.
Surg Endosc. 2013 Feb;27(2):642-7. doi: 10.1007/s00464-012-2507-x. Epub 2012 Sep 6.
The use of self-expandable stents to treat postoperative leaks and fistula in the upper gastrointestinal (GI) tract is an established treatment for leaks of the upper GI tract. However, lumen-to-stent size discrepancies (i.e., after sleeve gastrectomy or esophageal resection) may lead to insufficient sealing of the leaks requiring further surgical intervention. This is mainly due to the relatively small diameter (≤30 mm) of commonly used commercial stents. To overcome this problem, we developed a novel partially covered stent with a shaft diameter of 36 mm and a flare diameter of 40 mm.
From September 2008 to September 2010, 11 consecutive patients with postoperative leaks were treated with the novel large diameter stent (gastrectomy, n = 5; sleeve gastrectomy, n = 2; fundoplication after esophageal perforation, n = 2; Roux-en-Y gastric bypass, n = 1; esophageal resection, n = 1). Treatment with commercially available stents (shaft/flare: 23/28 mm and 24/30 mm) had been unsuccessful in three patients before treatment with the large diameter stent. Due to dislocation, the large diameter stent was anchored in four patients (2× intraoperatively with transmural sutures, 2× endoscopically with transnasally externalized threads).
Treatment was successful in 11 of 11 patients. Stent placement and removal was easy and safe. The median residence time of the stent was 24 (range, 18-41) days. Stent dislocation occurred in four cases (36 %). It was treated by anchoring the stent. Mean follow-up was 25 (range, 14-40) months. No severe complication occurred during or after intervention and no patient was dysphagic.
Using the novel large diameter, partially covered stent to seal leaks in the upper GI tract is safe and effective. The large diameter of the stent does not seem to injure the wall of the upper GI tract. However, stent dislocation sometimes requires anchoring of the stent with sutures or transnasally externalized threads.
使用自膨式支架治疗上消化道（GI）术后漏和瘘是治疗上消化道漏的一种既定方法。然而，管腔与支架大小的差异（例如袖状胃切除或食管切除后）可能导致漏口无法充分封闭，需要进一步的手术干预。这主要是由于常用商业支架的直径相对较小（≤30mm）。为了解决这个问题，我们开发了一种新型的部分覆盖支架，其轴直径为 36mm，喇叭口直径为 40mm。
从 2008 年 9 月至 2010 年 9 月，11 例连续的术后漏患者接受了新型大直径支架治疗（胃切除术，n=5；袖状胃切除术，n=2；食管穿孔后的胃底折叠术，n=2；Roux-en-Y 胃旁路术，n=1；食管切除术，n=1）。在使用大直径支架治疗之前，有 3 例患者曾使用商业可用支架（轴/喇叭口：23/28mm 和 24/30mm）治疗失败。由于移位，4 例患者的大直径支架被锚定（2 例术中经壁缝线固定，2 例经鼻外缝线固定）。
11 例患者中 11 例治疗成功。支架放置和取出既简单又安全。支架的中位留置时间为 24 天（范围 18-41 天）。支架移位发生在 4 例（36%），通过支架锚定进行了治疗。平均随访时间为 25 个月（范围 14-40 个月）。介入过程中和介入后均未发生严重并发症，无患者出现吞咽困难。
使用新型大直径、部分覆盖支架封闭上消化道漏是安全有效的。支架的大直径似乎不会对上消化道壁造成损伤。然而，支架移位有时需要用缝线或经鼻外缝线固定支架。
