Chung Kai-Chen, Lin Chih-Hung, Tsai Chung-Lin, Li Yu-Hsuan, Liao Chih-Hsiang
Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.
Division of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
World Neurosurg. 2019 May;125:67-71. doi: 10.1016/j.wneu.2019.01.149. Epub 2019 Feb 2.
Esophageal injury is a severe surgical complication of a transsternal approach to high thoracic vertebral metastasis, which can result in mediastinitis and life-threatening consequences. A covered stent can be placed in the esophagus to prevent mediastinal leakage. However, tracheomalacia is a rare complication following esophageal stenting.
A 56-year-old man had a pathologic fracture of the T3 vertebral body with spinal cord compression, myelopathy, and neurogenic bladder. An esophageal injury was noticed during the transsternal approach. Immediate suture repair, drainage tube placement, and subsequent esophageal stenting were carried out. One month after discharge, the endoscopic examination revealed nonhealing of the esophagus, and a new covered stent was replaced. Episodes of severe stridor and dyspnea led to the patient being sent to the emergency department. Computed tomography scan of the chest revealed a focal collapse of the trachea at the thoracic inlet, and tracheomalacia was suspected. The covered stent was removed, despite nonhealing of the esophagus. His stridor, dyspnea, and constant coughing subsided afterwards. The endoscopic examination at 3 months after stent removal showed complete healing of the esophagus.
Esophageal stenting can be used to prevent mediastinal leakage due to esophageal injury in the transsternal approach for high thoracic vertebral metastasis, but the stent might be a cause of tracheomalacia. Stent removal should be considered if upper airway obstruction occurs. Awareness of the radial force of the stent, esophageal composition (e.g., status post suture repair), and esophageal diameter must be considered for optimal stent tolerance to avoid complications.
食管损伤是经胸骨入路治疗高位胸椎转移瘤的一种严重手术并发症，可导致纵隔炎及危及生命的后果。可在食管内放置带膜支架以预防纵隔渗漏。然而，气管软化是食管支架置入术后一种罕见的并发症。
一名56岁男性，T3椎体病理性骨折，伴有脊髓受压、脊髓病和神经源性膀胱。经胸骨入路手术过程中发现食管损伤。当即进行了缝合修复、放置引流管，并随后置入食管支架。出院1个月后，内镜检查显示食管未愈合，遂更换了新的带膜支架。严重的喘鸣和呼吸困难发作导致患者被送往急诊科。胸部计算机断层扫描显示胸廓入口处气管局灶性塌陷，怀疑为气管软化。尽管食管未愈合，仍移除了带膜支架。此后，患者的喘鸣、呼吸困难和持续咳嗽症状缓解。支架移除3个月后的内镜检查显示食管完全愈合。
食管支架可用于预防经胸骨入路治疗高位胸椎转移瘤时因食管损伤导致的纵隔渗漏，但该支架可能是气管软化的一个原因。如果发生上气道梗阻，应考虑移除支架。为使支架耐受性达到最佳以避免并发症，必须考虑支架的径向力、食管构成（如缝合修复后的状态）和食管直径。
