置管引流联合医用胶治疗胸腔内吻合口瘘9例

目的评价DSA下置管引流联合医用胶封堵治疗胸腔内吻合口瘘的疗效。方法回顾2016年8月至2018年5月食管癌或胃癌术后胸腔内吻合口瘘的患者9例,分析应用DSA下置管引流联合医用胶封堵治疗吻合口瘘的愈合情况。结果 9例患者均经口服泛影葡胺确诊,3例存在食管气管瘘,所有患者均经鼻成功置入三腔喂养管和引流管,经2~5 d引流后感染症状得到控制,2~3周后复查提示瘘口缩小、瘘道形成。引流量<10 mL/d行造影复查,瘘口<0.5 cm并有瘘道形成时,DSA下经4 F单弯导管使用医用胶与碘化油混合液0.5~2 mL封堵瘘道,所有患者均一次性成功封堵。封堵术后观察1周后正常进食,拔管后痊愈出院,瘘口平均愈合时间35 d。结论 DSA下置管引流联合医用胶治疗胸腔内吻合口瘘可以提高瘘口封堵成功率,有效促进瘘口愈合,为一种有益的尝试。

Catheter drainage combined with medical glue occlusion for the treatment of intrathoracic anastomotic fistulae: preliminary results in 9 patients

Objective To evaluate the efficacy of digital subtraction angiography-guided(DSA-guided) catheter drainage combined with medical glue occlusion in treating intrathoracic anastomotic fistulae. Methods A total of 9 patients with intrathoracic anastomotic fistula following esophagectomy or total gastrectomy, who were admitted to hospital during the period from August 2016 to May 2018, were enrolled in this study. DSA-guided catheter drainage combined with medical glue occlusion was performed in all patients, and the healing of anastomotic fistulae was analyzed. Results The diagnosis was confirmed by radiography with oral meglumine diatrizoate in all 9 patients. Three patients had esophagotracheal fistula. Successful implantation of three-chamber feeding tube and drainage catheter via nasal route was accomplished in all patients. The infection symptoms were under control after drainage for 2-5 days. Reexamination 2-3 weeks after drainage showed that the fistula was narrowed and the fistulous tract was formed. Contrast radiography reexamination was performed when the drainage volume was less than 10 mL/day. DSA-guided fistulous tract occlusion with 0.5-2 mL mixed solution of medical glue and lipiodol via a 4 F single-bend catheter was carried out if the orificium fistulae was <0.5 cm together with fistula formation, and successful medical glue occlusion of the orificium fistulae with single procedure was achieved in all patients. After occlusion procedure the patients were kept under close observation for one week, and then the patients were allowed to take normal meal. The patients were discharged after extubation. The average healing time of fistula was 35 days. Conclusion In treating intrathoracic anastomotic fistulae, DSA-guided catheter drainage combined with medical glue occlusion can improve the success rate of fistula closure and effectively promote the healing of fistula. This study is a valuable attempt for the treatment of thoracic anastomotic fistula.