应用被膜金属支架封堵气道瘘

 

【摘要】  目的  食管气管瘘（ERF）是临床最常见的一种气道瘘。本文旨在探讨被膜金属支架(CZTS)封堵ERF的疗效和安全性。 方法  ERF患者在气管镜和/或X线透视下放置CZTS。原发食管肿瘤34例，肺癌12例，甲状腺癌2例。 结果 48例患者共有52个瘘口，口径0.3 cm-7.0cm。瘘口多位于主气管中下端和双侧支气管开口。伴发BPF和EMF各2例, TMF和EPF各1例。放置CZTS 52个（其中Y形 36，L和I各8）。食管放置被膜金属支架28个。50个瘘口封堵疗效：CR 4.0%，cCR 68.0%，PR 18.0%, NR 10.0%。中位生存时间6个月。 结论  被膜金属支架能有效封堵ERF、BPF和TMF。选择合适形状的支架最为重要。分叉型气管支架尤其适于隆突周围瘘口。煤炭总医院呼吸内科王洪武

 

Application of Covered Metalic Stents for Sealing of Airway Fistulas

Hongwu WANG, Dongmei LI，Nan ZHANG，Hang ZOU, Lingfei LUO, Hongming MA, Yunzhi ZHOU, Jing LI, Sujuan LIANG

Minimal Invasive Tumor Therapy Center, Meitan General Hospital, Beijing 100028,China

Corresponding author：Hongwu WANG, E-mail:[e-mail]

【Abstract】

Objective Esophagorespiratory fistula (ERF)  is the most common airway fistula，which is very difficult to be treated. This study is to evaluate the safety and clinical efficacy of metallic covered Z-type stents (CZTS) for sealing of airway fistulas. Methods Patients with ERFs were retrospectively reviewed for the treatment of CZTS by the guidance of bronchoscopy or fluroscopy. The fistulas were caused by esophageal（n=36），bronchogenic (n = 12) and thyroid （n=2）carcinomas.

Results There were 50 ERFs in 48 patients with fistula size from 0.5 cm to 7.0cm. Most of ERFs were located in middle & lower trachea or bilateral bronchial orifices. The coexisting fistulas were bronchus-pleural fistulas(BPF，2cases), trachea-mediastinal  fistulas (TMF，1 case),  esophagus-mediastinal  fistulas (EMF，2 cases) and esophagus-pleural fistula(EPF，1 case). 52 CZTS （36 Y-shaped ，8 L-shaped and 8 I-shaped）and 28 esophagus metal stents had been placed.  The sealing effects of fistulas were complete response 4.0%，clinical complete response （ cCR）68.0%, partial response(PR) 18.0%, no response(NR) 10.0%. The effective rate was 90.0%.The median survival duration of all patients was 6 months. Conclusions The use of CZTS appears to be safe and feasible for the palliative treatment of  ERF，BPF and TMF. Airway stent placement should be of choice in patients with ERF, and then esophagus stents should be given if airway stents were failed. Airway bifurcation stents were especially suitable for the sealing of fistulas near trachea carina. 

【Key words】Esophagus neoplasma; Lung neoplasma; Esophageorespiratory fistula; Stents