Oprisanescu Denisa, Bucur Denisa, Sandru Vasile, Nedelcu Ioan Cristian, Ilie Madalina, Oprita Ruxandra, Constantinescu Gabriel
Chirurgia (Bucur). 2018 Jan-Feb;113(1):108-115. doi: 10.21614/chirurgia.113.1.108.
Non-malignant esophageal fistulas have a wide spectrum of clinical and pathological features and it`s important to learn to detect and treat them, due to significant morbidity, mortality and costs. The need for minimally invasive, efficient and also quick procedures is imperative. Esophageal stenting using fully-covered expandable stents has become an increasingly preferred option and addresses to fistulas which arise from 2-3 cm beyond Killian's mouth and up to the gastroesophageal junction. The long-term purpose of the procedure is closure of the fistula and thus healing. A second goal would be avoiding the complications generated by long-term wearing of the stent, such as gastrointestinal perforation and stenosis.
This review focuses on the efficacy of fully-covered metallic stents in treating benign esophageal fistulas. To this effect, we performed a retrospective study on 21 patients admitted in our clinic between January 2014 and April 2017 for non-malignant esophageal fistulas. The selection criteria were the following: post-operative fistulas (gastric sleeve, fundoplication for transhiatal gastric hernia, even malignancies for which surgical tumor removal was performed), foreign body acquired fistulas, post-traumatic fistulas. Esophago-jejunal anastomotic fistulas were also included in the study (following complete gastrectomy). The efficacy of esophageal stenting was proven in 76% of the cases, resulting in fistula closure. The rest of the patients either didn't achieve fistula closure or couldn't tolerate the stent, calling for early removal of the prosthesis. Reintervention procedures such as stent repositioning or stent replacement (with higher diameter) were carried out in 42% of the cases. A percentage of 19% of the patients who achieved fistula closure developed esophageal stricture on stent-induced ulcers and needed recalibration stenting or esophageal Savary dilation. 22% of the cases needed surgical drainage for infected collections developed simultaneously. We recorded 2 deaths, unrelated to the stenting procedure. Patients who didn't acquire fistula closure were referred to thoracic surgery in good physical condition. Fully-covered metallic esophageal stents can be successfully used to treat benign esophageal fistulas. Follow-up of the patient in order to see if stent repositioning or replacement is needed is crucial. Special design esophageal stents are highly recommended and must not lack. Close cooperation with thoracic surgery is indispensable.
非恶性食管瘘具有广泛的临床和病理特征，鉴于其较高的发病率、死亡率和成本，学会检测和治疗它们很重要。迫切需要微创、高效且快速的手术。使用全覆膜可扩张支架进行食管支架置入术已成为越来越受欢迎的选择，适用于起源于基利安口部以外2 - 3厘米直至胃食管交界处的瘘管。该手术的长期目标是闭合瘘管从而实现愈合。第二个目标是避免长期佩戴支架产生的并发症，如胃肠道穿孔和狭窄。
本综述聚焦于全覆膜金属支架治疗良性食管瘘的疗效。为此，我们对2014年1月至2017年4月间因非恶性食管瘘入住我院的21例患者进行了回顾性研究。选择标准如下：术后瘘（胃袖状切除术、经裂孔胃疝胃底折叠术，甚至是行肿瘤切除手术的恶性肿瘤）、异物所致瘘、创伤后瘘。食管空肠吻合口瘘（全胃切除术后）也纳入研究。76%的病例证明食管支架置入术有效，实现了瘘管闭合。其余患者要么未实现瘘管闭合，要么无法耐受支架，需要早期取出假体。42%的病例进行了诸如支架重新定位或更换（更大直径）等再次干预手术。19%实现瘘管闭合的患者因支架诱导溃疡出现食管狭窄，需要重新校准支架置入术或食管Savary扩张术。22%的病例因同时出现感染性积液需要手术引流。我们记录到2例死亡，与支架置入术无关。未实现瘘管闭合的患者在身体状况良好时被转诊至胸外科。全覆膜金属食管支架可成功用于治疗良性食管瘘。对患者进行随访以确定是否需要重新定位或更换支架至关重要。强烈推荐使用特殊设计的食管支架且不可或缺。与胸外科密切合作必不可少。
