Wang Hongwu, Tao Meimei, Zhang Nan, Li Dongmei, Zou Hang, Zhang Jieli, Luo Lingfei, Ma Hongming, Zhou Yunzhi
Department of Medical Oncology (HW, NZ, DL, HZ, JZ, LL, HM); and the Department of Respiratory Medicine (MT, YZ) Meitan General Hospital, Beijing, China.
Am J Med Sci. 2015 Nov;350(5):364-8. doi: 10.1097/MAJ.0000000000000565.
Malignant tracheoesophageal fistula (MTEF) is a devastating complication of esophageal cancer, lung cancer or other carcinoma with a shorter life-span and poor life quality. The aim of this study was to assess the effect of airway stent insertion on MTEF patients.
A total of 63 MTEF patients were included, 12 patients with lung cancer and 46 patients with esophageal cancers. Eight zones were proposed to classify various fistula locations. Airway stents were selected based on the various zones and fistula size.
Airway stents were successfully inserted in all patients, and both airway and esophageal stents in 8 patients. Most fistula were located in locations II (18/63, 28.6%), III (22/63, 34.9%), then VII (9/63, 14.3%). The stents included 10 (15.9%) I shaped, 8 (12.7%) L shaped and 45 (71.4%) Y shaped. Different stents were placed based on different locations and sizes of fistulas. Overall, mean survival time was 163 days (2-270 days). Most symptoms relieved after stent insertion. Mean Karnofsky score jumped from 43.0 ± 10.7 before stent placement to 66.7 ± 10.8 after stent insertion (P = 0.000). Complete closure was achieved in 45 patients (71.4%), and incomplete closure and leakage were found in 18 patients.
Airway stent insertion provides an effective approach to improve symptoms and quality of life. The choice of stent based on different fistula location and size may be a reasonable way in clinical practice.
恶性气管食管瘘（MTEF）是食管癌、肺癌或其他癌症的一种严重并发症，患者寿命较短且生活质量差。本研究旨在评估气道支架置入对MTEF患者的疗效。
共纳入63例MTEF患者，其中肺癌患者12例，食管癌患者46例。提出了8个区域对不同的瘘口位置进行分类。根据不同区域和瘘口大小选择气道支架。
所有患者均成功置入气道支架，8例患者同时置入了气道和食管支架。大多数瘘口位于II区（18/63，28.6%）、III区（22/63，34.9%），然后是VII区（9/63，14.3%）。支架包括10个（15.9%）I形、8个（12.7%）L形和45个（71.4%）Y形。根据瘘口的不同位置和大小放置不同的支架。总体而言，平均生存时间为163天（2 - 270天）。大多数症状在支架置入后缓解。平均卡诺夫斯基评分从支架置入前的43.0±10.7跃升至置入后的66.7±10.8（P = 0.000）。45例患者（71.4%）实现了完全闭合，18例患者发现不完全闭合和渗漏。
气道支架置入为改善症状和生活质量提供了一种有效的方法。根据不同的瘘口位置和大小选择支架可能是临床实践中的一种合理方法。
