Donatelli Gianfranco, Dhumane Parag, Perretta Silvana, Dallemagne Bernard, Vix Michele, Mutter Didier, Dritsas Stavros, Doffoel Michel, Marescaux Jacques
IRCAD/EITS, Department of Gastrointestinal and Endocrinal Surgery, University of Strasbourg, Strasbourg, France.
J Minim Access Surg. 2012 Oct;8(4):118-24. doi: 10.4103/0972-9941.103109.
Fully covered self-expanding metal stent (SEMS) placement has been successfully described for the treatment of malignant and benign conditions. The aim of this study is to evaluate our experience of fully covered SEMS placement for post-operative foregut leaks.
Retrospective analysis was done for indications, outcomes and complications of SEMS placed in homogeneous population of 15 patients with post-operative foregut leaks in our tertiary-care centre from December 2008 to December 2010. Stent placement and removal, clinical and radiological evidence of leak healing, migration and other complications were the main outcomes analyzed.
Twenty-three HANAROSTENT(®) SEMS were successfully placed in 14/15 patients (93%) with post-operative foregut leaks for an average duration of 28.73 days (range=1-42 days) per patient and 18.73 days per SEMS. Three (20%) patients needed to be re-stented for persistent leaks ultimately resulting in leak closure. Total 5/15 (33.33%) patients and 7/23 (30.43%) stents showed migration; 5/7 (71.42%) migrated stents could be retrieved endoscopically. There were mucosal ulceration in 2/15 (13.33%) and pain in 1/15 (6.66%) patients.
Stenting with SEMS seems to be a feasible option as a primary care modality for patients with post-operative foregut leaks.
全覆膜自膨式金属支架（SEMS）置入术已成功应用于治疗恶性和良性疾病。本研究的目的是评估我们使用全覆膜SEMS治疗术后前肠漏的经验。
对2008年12月至2010年12月在我们三级医疗中心接受治疗的15例术后前肠漏患者进行回顾性分析，这些患者情况均一，分析SEMS置入的适应证、结局和并发症。主要分析指标包括支架置入与取出情况、漏口愈合的临床和影像学证据、支架移位及其他并发症。
14/15例（93%）术后前肠漏患者成功置入23枚HANAROSTENT（®）SEMS，每位患者平均置入时间为28.73天（范围为1 - 42天），每枚SEMS平均置入时间为18.73天。3例（20%）患者因持续漏液需要再次置入支架，最终漏口闭合。15例患者中有5例（33.33%）、23枚支架中有7枚（30.43%）发生移位；7枚移位支架中有5枚（71.42%）可通过内镜取出。15例患者中有2例（13.33%）出现黏膜溃疡，1例（6.66%）出现疼痛。
对于术后前肠漏患者，使用SEMS进行支架置入似乎是一种可行的主要治疗方式。
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