Yanık Fazlı, Karamustafaoğlu Yekta Altemur, Yörük Yener
Department of Thoracic Surgery, Medicine Faculty of Trakya University, Edirne, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2019 Jan 1;27(1):88-92. doi: 10.5606/tgkdc.dergisi.2019.16755. eCollection 2019 Jan.
This study aims to report our experience with esophageal self-expendable metal stents for the palliation of malignant dysphagia and tracheoesophageal fistulas caused by lung cancer.
Esophageal self-expandable metal stents were deployed in 56 patients (55 males, 1 female; mean age 63.5 years; range, 42 to 79 years) with malignant dysphagia due to lung cancer between August 2002 and May 2018. Of the patients, 34 had received previous chemoradiotherapy, eight only chemotherapy, and three only radiotherapy, while four had pneumonectomy. Tracheoesophageal fistula was coexisting in 12 patients (21%). Stents were inserted under fluoroscopic control over guide-wire in 28 patients and under flexible endoscopic control in the remaining 28 patients. One stent was used in all patients, except two patients with tracheoesophageal fistula, one patient who had an external compression causing downward migration of stent, and two patients who had tumor progression.
Dysphagia improved in all patients after stent insertion. Tracheoesophageal fistula was sealed off in all patients. All patients remained asymptomatic without dysphagia symptoms during the follow-up period except for two patients who underwent gastrostomy. All patients with tracheoesophageal fistula died. Their mean duration of survival was 2.8 months. Of the patients with tracheoesophageal fistula, one died of mediastinitis, one died of esophageal perforation, while the others died of cancer-related reasons. Of the dysphagia patients without tracheoesophageal fistula, all died except for two patients. Mean duration of survival in this group was 4.3 months.
Dysphagia in lung cancer may have many underlying reasons. Self-expandable metal stents may provide satisfactory relief of dysphagia symptoms with minimal morbidity after a single procedure in patients with limited lifespan.
本研究旨在报告我们使用食管自膨式金属支架缓解肺癌所致恶性吞咽困难和气管食管瘘的经验。
2002年8月至2018年5月期间，对56例（55例男性，1例女性；平均年龄63.5岁；范围42至79岁）因肺癌导致恶性吞咽困难的患者置入食管自膨式金属支架。其中34例患者曾接受过放化疗，8例仅接受过化疗，3例仅接受过放疗，4例接受过肺切除术。12例患者（21%）并存气管食管瘘。28例患者在透视引导下经导丝置入支架，其余28例患者在可弯曲内镜引导下置入支架。除2例气管食管瘘患者、1例因外部压迫导致支架向下移位的患者以及2例肿瘤进展的患者外，所有患者均使用1枚支架。
所有患者置入支架后吞咽困难均有改善。所有患者的气管食管瘘均被封堵。除2例行胃造瘘术的患者外，所有患者在随访期间均无症状且无吞咽困难症状。所有气管食管瘘患者均死亡。其平均生存时间为2.8个月。在气管食管瘘患者中，1例死于纵隔炎，1例死于食管穿孔，其余死于癌症相关原因。在无气管食管瘘的吞咽困难患者中，除2例患者外均死亡。该组患者的平均生存时间为4.3个月。
肺癌所致吞咽困难可能有多种潜在原因。自膨式金属支架可为寿命有限的患者在单次手术后以最小的发病率提供令人满意的吞咽困难症状缓解。
