Department of Oncology, Emergency General Hospital, No. 29 Xibahe Nanli, Chaoyang District, Beijing, 100028, China.
Department of Oncology, Emergency General Hospital, Beijing, China.
Ther Adv Respir Dis. 2019 Jan-Dec;13:1753466619871523. doi: 10.1177/1753466619871523.
Thoracogastric-airway fistula (TGAF) post-thoracic surgery is a rare and challenging complication for esophagectomy. The aim of this study was to explore the effectiveness of airway stenting for TGAF patients and find related factors coupled with healing of fistula.
This is a retrospective study involving patients with TGAF who were treated with airway stentings. Based on different TGAF locations and sizes on chest computed tomography, covered metallic or silicon airway stents were implanted to cover orifices under interventional bronchoscopy. TGAF healing was defined as the primary outcome, and complete sealing of TGAF as the second outcome. The predictors for TGAF healing were analyzed in univariate and multivariate analysis.
A total of 58 TGAF patients were included, of whom 7 received straight covered metallic stents, 5 straight silicon stents, 3 L-shaped covered metallic stents, 21 large Y-shaped covered metallic stents, 17 large Y-shaped silicon stents, and 5 with Y-shaped covered metallic stents. Healing was achieved in 20 (34.5%) patients, and complete sealing in 45 (77.6%) patients. There were no significant differences in healing rate and complete sealing rate between patients receiving metallic stents and those with silicon stents. In univariate analysis, lacking a previous history of radiotherapy or chemotherapy, nonmalignant fistulas, small fistulas, and shorter postesophagectomy duration were found associated with a higher rate of TGAF healing. Only shorter postesophagectomy duration was associated with TGAF healing in multivariate analysis.
Both silicon and covered metallic airway stenting are effective methods to close TGAF. A shorter postesophagectomy period may predict better TGAF healing.
胸胃气道瘘（TGAF）是胸外科手术后一种罕见且具有挑战性的并发症，对于食管切除术患者而言更是如此。本研究旨在探讨气道支架置入治疗 TGAF 患者的有效性，并寻找与瘘管愈合相关的因素。
这是一项回顾性研究，纳入了接受气道支架治疗的 TGAF 患者。根据胸部 CT 上 TGAF 的不同位置和大小，在介入性支气管镜下植入覆盖型金属或硅酮气道支架，以覆盖气道口。TGAF 愈合定义为主要结局，完全封闭 TGAF 定义为次要结局。在单因素和多因素分析中，分析了 TGAF 愈合的预测因素。
共纳入 58 例 TGAF 患者，其中 7 例接受直型覆盖金属支架，5 例接受直型硅酮支架，3 例接受 L 型覆盖金属支架，21 例接受大 Y 型覆盖金属支架，17 例接受大 Y 型硅酮支架，5 例接受 Y 型覆盖金属支架。20 例（34.5%）患者实现愈合，45 例（77.6%）患者完全封闭。金属支架组和硅酮支架组的愈合率和完全封闭率无显著差异。单因素分析显示，无放疗或化疗史、非恶性瘘管、瘘管较小、食管切除术后时间较短与 TGAF 愈合率较高相关。多因素分析仅显示食管切除术后时间较短与 TGAF 愈合相关。
硅酮和覆盖型金属气道支架均是封闭 TGAF 的有效方法。食管切除术后时间较短可能预示着更好的 TGAF 愈合。
