Han Xinwei, Zhao Yan Shi, Fang Yi, Qi Yu, Li Xiangnan, Jiao Dechao, Ren Kewei, Wu Gang
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Division of Gastroenterology and Hepatology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, California.
J Surg Oncol. 2016 Nov;114(6):725-730. doi: 10.1002/jso.24384. Epub 2016 Sep 22.
Perforated esophageal carcinoma with mediastinal abscess is a clinically life-threatening emergency. Herein, we summarize our experience with placement of transnasal drainage catheters and covered esophageal stents for the treatment of this condition.
We retrospectively assessed the medical records of 20 patients who were treated using our intervention protocol. Patients received local anesthesia and sedation prior to transnasal drainage catheter placement into the mediastinal abscess, which was followed by esophageal stent placement. Once the fluid was completely drained and the abscess was completely closed, the drainage catheter was removed.
The placement of the drainage catheter and stent was successful in all patients. The drainage catheter was successfully removed from the mediastinum after 7-60 days in 14 patients. During the follow-up of 1-18 months, six patients died from hemorrhage, eight from cancer progression or pulmonary infection, one from atrial fibrillation, and one from asphyxia caused by tracheal compression. The remaining four patients can eat normally.
Placement of transnasal drainage catheters and covered esophageal stents may be an appropriate palliative therapy for patients with perforated esophageal carcinoma with mediastinal abscess who are not candidates for surgery or have a high postoperative risk. J. Surg. Oncol. 2016;114:725-730. © 2016 Wiley Periodicals, Inc.
伴有纵隔脓肿的穿孔性食管癌是一种临床上危及生命的急症。在此，我们总结经鼻引流导管置入和覆膜食管支架置入治疗这种疾病的经验。
我们回顾性评估了20例采用我们的干预方案进行治疗的患者的病历。患者在经鼻将引流导管置入纵隔脓肿之前接受局部麻醉和镇静，随后置入食管支架。一旦液体完全引流且脓肿完全闭合，即移除引流导管。
所有患者的引流导管和支架置入均成功。14例患者在7 - 60天之后成功从纵隔移除引流导管。在1 - 18个月的随访期间，6例患者死于出血，8例死于癌症进展或肺部感染，1例死于心房颤动，1例死于气管受压导致的窒息。其余4例患者能够正常进食。
经鼻引流导管置入和覆膜食管支架置入对于不适合手术或术后风险高的伴有纵隔脓肿的穿孔性食管癌患者可能是一种合适的姑息治疗方法。《外科肿瘤学杂志》2016年；114:725 - 730。©2016威利期刊公司
