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恶性食管-呼吸道瘘闭合的技术困难和程序并发症。

TECHNICAL DIFFICULTIES AND PROCEDURAL COMPLICATIONS IN CLOSING MALIGNANT ESOPHAGEAL-RESPIRATORY FISTULAS.

机构信息

1Gastroenterology Department, Iasi Regional Institute of Oncology, Iasi, Romania; 2Grigore T. Popa University of Medicine and Pharmacy; Faculty of Medicine, Surgery Department 2, Iasi Regional Institute of Oncology, Iasi, Romania; 3Iasi University of Medicine and Pharmacy, Faculty of Medicine, Anesthesiology and Intensive Care Department, Iasi Regional Institute of Oncology, Iasi, Romania.

出版信息

Acta Clin Croat. 2021 Dec;60(4):703-710. doi: 10.20471/acc.2021.60.04.18.

DOI:10.20471/acc.2021.60.04.18
PMID:35734501
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9196228/
Abstract

The aim of the study was to outline technical difficulties and procedural complications of using partially covered esophageal self-expandable metal stents (SEMSs) in malignant esophageal respiratory fistulas (ERFs) as a palliative treatment option. In this study, 150 patients with malignant dysphagia underwent treatment with SEMSs. A total of 36 ERFs were detected through endoscopic or clinical assessment. Complete fistula sealing with SEMSs was possible in 35 of the 36 patients. The majority of fistulas were diagnosed in male patients with advanced esophageal cancer. All of them presented with prolonged dysphagia and cachexia. Stent migration or tumoral overgrowth was identified in 6 cases with recurrent dysphagia, and required a second stent insertion. SEMSs were highly efficient in 98% of the patients studied with ERFs, with successfully sealed ERFs after the first attempt, with an overall median survival rate of 92 days. The technique of esophageal SEMS placement is simple and can be rapidly mastered. Patients with ERFs have a respiratory shunt that makes intubation difficult and is often avoided. Restoring oral feeding increased the patient quality of life. SEMS placement is generally safe, but has few associated postoperative complications.

摘要

本研究旨在概述在恶性食管呼吸瘘（ERF）中使用部分覆盖食管自膨式金属支架（SEMS）作为姑息治疗选择的技术难点和程序并发症。在这项研究中，150 名恶性吞咽困难患者接受了 SEMS 治疗。通过内镜或临床评估共发现 36 例 ERF。36 例患者中有 35 例通过 SEMS 完全封闭瘘口。大多数瘘管是在患有晚期食管癌的男性患者中诊断出来的。他们都表现出长期的吞咽困难和恶病质。6 例复发性吞咽困难患者因支架迁移或肿瘤过度生长而被识别，并需要再次插入支架。在研究的患有 ERF 的患者中，SEMS 非常有效，98%的患者在第一次尝试后成功封闭 ERF，总体中位生存率为 92 天。食管 SEMS 放置技术简单，可迅速掌握。患有 ERF 的患者存在呼吸分流，使插管变得困难，通常会避免插管。恢复口服喂养提高了患者的生活质量。SEMS 放置通常是安全的，但术后并发症很少。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/c309b5f1a3be/acc-60-703-f10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/3a943d080ae9/acc-60-703-f1.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/0715f24f48cd/acc-60-703-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/a85548fa7d0d/acc-60-703-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/f1a820fb4208/acc-60-703-f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/f9a4e19243b1/acc-60-703-f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/9775bee32fa6/acc-60-703-f7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/6c6de761229e/acc-60-703-f8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/87698dc1cb97/acc-60-703-f9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/c309b5f1a3be/acc-60-703-f10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/3a943d080ae9/acc-60-703-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/c328f2ee4774/acc-60-703-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/0715f24f48cd/acc-60-703-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/a85548fa7d0d/acc-60-703-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/f1a820fb4208/acc-60-703-f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/f9a4e19243b1/acc-60-703-f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/9775bee32fa6/acc-60-703-f7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/6c6de761229e/acc-60-703-f8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/87698dc1cb97/acc-60-703-f9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa29/9196228/c309b5f1a3be/acc-60-703-f10.jpg

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