The Methodist Hospital, Houston, Texas; Weill Cornell College of Medicine, Columbia University, New York, New York.
The University of Texas MD Anderson Cancer Center, Houston, Texas.
Ann Thorac Surg. 2014 Jul;98(1):297-303; discussion 303-4. doi: 10.1016/j.athoracsur.2014.01.063. Epub 2014 May 13.
Esophageal stent leaks can have catastrophic consequences if not promptly recognized and managed appropriately. However, there are different mechanisms for esophageal stent leaks that may demonstrate unique features in presentation and response to management strategy. The objective of this study was to develop a classification system for esophageal leaks and assess distinctions between leak types.
Patients with esophageal stent leaks from 2007 to 2010 managed at The Methodist Hospital were classified into the following 5 leak types: type 1, proximal; 2, distal retrograde; 3, stent lining; 4, between stents; and 5, migrated stent. Patients' baseline characteristics, procedural data, and outcomes were analyzed.
Of the 89 patients who underwent esophageal stenting, 23 stent leaks were identified after the first procedure. Mean age was 57±14 years, 61% were male, 43% had esophageal cancer, and 52% were status postesophagectomy. Seven of the leaks were type 1, 6 were type 2, 2 were type 3, 4 were type 4, and were type 5. The vast majority (70%) of leaks were detected within the first 48 hours. The management of leaks varied significantly depending on the leak type (p<0.001) and included additional stenting, placement of a larger stent, bridle, percutaneous gastrostomy, stent exchange, observation, and surgery. The majority of leaks (65%) ultimately resolved. Survival according to leak type was not different (p=0.072).
Esophageal leaks tend to be managed differently depending on leak type. The majority of leaks ultimately resolve with stenting. Our proposed leak classification may enhance esophageal stent management strategy.
食管支架渗漏如果不能及时发现并适当处理，可能会产生灾难性的后果。然而，食管支架渗漏有不同的机制，在表现和对处理策略的反应上可能具有独特的特征。本研究的目的是建立一种食管渗漏分类系统，并评估不同渗漏类型之间的区别。
对 2007 年至 2010 年在卫理公会医院接受治疗的食管支架渗漏患者进行分类，分为以下 5 种渗漏类型：1 型，近端；2 型，远端逆行；3 型，支架衬里；4 型，支架之间；5 型，移位支架。分析患者的基线特征、手术数据和结局。
在 89 例接受食管支架置入术的患者中，首次手术后发现 23 例支架渗漏。平均年龄为 57±14 岁，61%为男性，43%患有食管癌，52%为食管切除术后。7 例为 1 型，6 例为 2 型，2 例为 3 型，4 例为 4 型，5 例为 5 型。绝大多数（70%）渗漏发生在最初的 48 小时内。根据渗漏类型，渗漏的处理方法存在显著差异（p<0.001），包括额外的支架置入、放置更大的支架、吊带、经皮胃造口术、支架交换、观察和手术。大多数渗漏（65%）最终得到解决。根据渗漏类型的生存情况没有差异（p=0.072）。
根据渗漏类型，食管渗漏的处理方法往往不同。大多数渗漏最终通过支架置入得到解决。我们提出的渗漏分类方法可能会增强食管支架处理策略。
