晚期食管癌放疗术后食管胸腔瘘形成的介入治疗

目的探索经鼻、食管引流及覆膜支架植入术治疗食管胸腔瘘的可行性及临床价值。方法7例男5例,女2例,年龄46~75岁,平均(56±6.7)岁]放疗术后食管胸腔瘘患者,采用5F猪尾巴多侧孔导管经鼻、食管及瘘口行胸腔引流,并利用食管覆膜内支架封堵食管瘘口。术后经引流导管定时冲洗、闭室引流脓腔,定期复查食管及脓腔造影。结果所有患者引流导管及堵瘘支架植入均获得成功;持续引流第2天,患者精神状况明显好转,体温开始下降,其后引流液逐渐减少。引流、冲洗脓腔持续12~22 d,平均15 d;术后多次复查食管造影未发现瘘口复发,拔管前引流管造影提示脓腔明显变小或闭塞、液气胸得到明显控制,拔管后食管造影示瘘口封堵满意、支架完全复张,未见明显移位、狭窄等征象。结论经鼻、食管引流及覆膜支架植入术治疗食管癌放疗术后胸腔瘘是可行的、安全的,疗效肯定。

Interventional therapy of esophageal thoracic cavity fistula after irradiation therapy of advanced esophagus carcinoma

Objective To explore the feasibility and value of treating thoracic cavity fistula with covered esophageal stent through nasal esophagus drainage tube. Methods 7 cases (male 5 and female 2, average age years, range 46-75 years) with esophageal thoracic cavity fistula after irradiation therapy of advanced esophagus carcinoma were enrolled and treated by 5F pigtail side-holes catheter inserting into thoracic cavity through nasal esophagus and fistula, with covered stent placement in the esophagus to cover the fistula. The abscess cavities were washed and angiograghied regularly through drainage tubes. Results The insertion of the drainage tube and the placement of covered stent were successful. The consciousness condition of all patients was improved obviously after two days of constant drainage, with body temperature decreasing and quantity of drainage reducing gradually. The drainage tubes were placed in abscess cavities within 12-22 days, average 15 days. The angiography through drainage tubes showed that the abscess cavities disappeared or shrank obviously and hydropneumothorax was controlled and the fistulae were not recurrent before the drainage tubes being pulled out. The esophagogram after the drainage tubes being pulled out notified that the fistulae were covered satisfactorily, the stents inflated fully without displacement and stenosis. Conclusion Treating thoracic cavity fistula after irradiation therapy of advanced esophagus carcinoma with covered esophageal stent through nasal esophagus drainage tube is feasible and safe, clinical therapy is effective.