Stemerman D H, Caroline D F, Dabezies M, Mercader V P, Krevsky B, Gatenby R A
Department of Diagnostic Imaging, Temple University Hospital/School of Medicine, Broad and Ontario Streets, Philadelphia, PA 19140, USA.
Abdom Imaging. 1997 Jan-Feb;22(1):14-9. doi: 10.1007/s002619900131.
The aim was to evaluate the radiologic appearances and complications that occurred after placement of nonexpandable silicone stents used as palliative therapy for patients with malignant tracheoesophageal fistulas (TEFs).
Records of 11 patients (6 males, 5 females) who underwent placement of esophageal stents for malignant TEF between 1988 and 1994 were reviewed. Nine patients had esophageal carcinoma and two patients bronchogenic carcinoma. A TEF was documented radiographically in all patients. Silicone stents were placed in all patients under endoscopic guidance. A chest radiograph was obtained for each patient immediately following stent placement to confirm proper positioning and to assess complications. A contrast study was performed within 24 hours after the procedure to evaluate the function of the stent and its efficacy for occluding the fistulous tract. The patients were followed until January 1995 or until their death (range 1.5-24. 0 months).
Seven of the patients developed stent-related complications. Within the first 24 hours after stent insertion (which was successful in 100% of cases), 2 of the 11 patients developed minor complications. One patient had pooling of contrast around the proximal portion of the stent leading to aspiration of contrast, and one patient experienced transient, asymptomatic, idiopathic, esophagovenous intravasation. Delayed (>24 hours) complications related to stent placement occurred in five of the patients: one patient each had pooling at the proximal end of the stent with aspiration, worsening esophageal dysphagia causing reflux through the stent, caudad stent migration, superior stent migration, epithelial hyperplasia causing obstruction of the stent, and pressure necrosis. There were no cases of hemorrhage. Two patients were lost to long-term follow-up, and eight patients died of their disease, all unrelated to the stent placement.
Silicone esophageal stents provide successful short-term palliation for most patients with malignant TEF but are not without associated complications. These complications, however, can usually be detected early using radiographic imaging, permitting remediation.
目的是评估不可扩张硅酮支架置入后作为恶性气管食管瘘（TEF）患者姑息治疗的放射学表现及并发症。
回顾了1988年至1994年间11例（6例男性，5例女性）因恶性TEF接受食管支架置入术患者的记录。9例患者患有食管癌，2例患者患有支气管源性癌。所有患者均经影像学证实存在TEF。所有患者均在内镜引导下置入硅酮支架。支架置入后立即为每位患者拍摄胸部X线片，以确认位置正确并评估并发症。术后24小时内进行造影检查，以评估支架功能及其封堵瘘管的效果。对患者进行随访直至1995年1月或直至其死亡（范围为1.5 - 24.0个月）。
7例患者出现与支架相关的并发症。在支架置入后的最初24小时内（100%成功置入），11例患者中有2例出现轻微并发症。1例患者在支架近端周围出现造影剂积聚导致造影剂误吸，1例患者出现短暂、无症状、特发性食管静脉内渗。5例患者出现与支架置入相关的延迟（>24小时）并发症：1例患者在支架近端出现积聚并伴有误吸，1例患者食管吞咽困难加重导致通过支架反流，1例患者支架向尾端移位，1例患者支架向上移位，1例患者上皮增生导致支架阻塞，以及1例患者出现压力性坏死。无出血病例。2例患者失访，8例患者死于疾病，均与支架置入无关。
硅酮食管支架可为大多数恶性TEF患者提供成功的短期姑息治疗，但并非没有相关并发症。然而，这些并发症通常可通过放射影像学早期检测到，从而进行补救。
