Ong Gabie K B, Freeman Richard K
Department of Surgery, St. Vincent Hospital, Indianapolis, Indiana, USA.
Division of Thoracic and Cardiovascular Surgery, St. Vincent Hospital, Indianapolis, Indiana, USA.
J Thorac Dis. 2017 Mar;9(Suppl 2):S135-S145. doi: 10.21037/jtd.2017.03.100.
Traditionally, gold standard treatment for an acute esophageal perforation has been operative repair. Over the past two decades, there has been a paradigm shift towards the use of esophageal stents. Recent advances in biomaterial allowed a new generation of stents to be manufactured that combined (I) a non-permeable covering; (II) radial force sufficient to occlude a transmural esophageal injury and (III) improved ease of removability. The amalgamation of these developments set the stage for utilizing esophageal stents as part of the management algorithm of an acute esophageal perforation. This provides a safe and less invasive treatment route in lieu of direct primary repair and its well-documented significant failure rate. Esophageal stent placement for failed operative repair or esophageal leaks also had the potential to minimize the need for esophageal resection and diversion. When included in a multimodality hybrid treatment protocol, esophageal stents can optimize healing success rates and minimize the risks of adverse complications. This review summarizes the modern history of esophageal stent use in the treatment of esophageal perforation as well as the evidenced based recommendations for the use of esophageal stent placement in the treatment of acute esophageal perforation.
传统上，急性食管穿孔的金标准治疗方法是手术修复。在过去的二十年里，治疗模式已转向使用食管支架。生物材料的最新进展使得新一代支架得以制造出来，这种支架结合了：（I）不可渗透的覆盖层；（II）足以封闭食管全层损伤的径向力；以及（III）提高了可移除性。这些进展的融合为将食管支架用作急性食管穿孔治疗方案的一部分奠定了基础。这提供了一种安全且侵入性较小的治疗途径，以替代直接的一期修复及其有充分记录的高失败率。对于手术修复失败或食管漏的情况，放置食管支架还有可能减少食管切除和改道的必要性。当纳入多模式混合治疗方案时，食管支架可以优化愈合成功率并将不良并发症的风险降至最低。本综述总结了食管支架在治疗食管穿孔方面的现代应用历史，以及在急性食管穿孔治疗中使用食管支架置入的循证推荐。
