先天性食管闭锁合并气管食管瘘一例

病例:患儿男,1d,3450g,第1胎,第1产.患儿母孕43周,因不规则腹痛3d,胎动减少2d,隧到当地医院就诊.入院后发现,胎心慢、宫缩无力,故行剖宫产.术中见羊水量多,轻微粪染、无脐带绕颈.胎儿娩出后呈苍白窒息,阿氏评分3分,经气管插管、吸痰,心三联针、呼三联针肌肉注射,略缓解后转入我院新生儿科ICU病房.入院查体:体温36.3℃,呼吸36次/min,脉搏140次/min,血氧饱和度(SPO2)30%～40%.     

喉癌患者术后行食管癌手术并发食管气管瘘的治疗

<正>食管癌术后并发瘘是较严重且难治的并发症,尤其是食管气管瘘的治疗更困难。大多数患者会因感染、中毒及衰竭而死亡,少数患者度过急性期进入慢性期,极少数患者可以治愈。2013年12月我院1例喉癌患者术后3年患食管癌行手术治疗并发食管气管瘘,经治疗效果满意,现报告如下。1资料与方法患者,男,70岁,3年前因早期喉癌行手术切除治疗,术后长期声音嘶哑。本次因进行性吞咽困难2个月入院。胃镜检     

食道双支架置入治疗食管气管瘘临床初探

目的 探讨全裸金属支架联合被膜金属支架(双支架置入)封堵食管气管瘘的疗效和安全性.方法 对10例食管气管瘘患者,在X线透视下向食管内放置双支架.结果 10例患者的原发病均为肺癌,共有10个瘘口,口径0.5 ～5.0 cm.每例均成功置入裸支架及被膜金属支架各1枚,术中及术后未出现严重并发症.治疗效果:临床完全缓解7例(70％),部分缓解3例(30％),有效率为100％.结论 全裸金属支架联合被膜金属支架(双支架置入)是一个安全有效的治疗手段.     

先天性食管气管瘘误诊1例

先天性食管气管瘘误诊１例甘肃省定西地区医院儿科（７４３０００）蒋维国病例报告患儿男，２月，住院号４８４１４，自生后第二天喂奶时出现呛咳，发绀，阵发性咳嗽，憋气，以哭闹时为甚，腹胀，吃奶过猛及仰卧位时加剧，而且呈进行性加重，曾在当地县医院以＂肺炎＂、＂...     

先天性食管闭锁及气管食管瘘一例并文献复习

目的提高对先天性食管闭锁及气管食管瘘的认识水平。方法通过分析本科收治的先天性食管闭锁及气管食管瘘1例和复习先天性食管闭锁及气管食管瘘的文献5篇76例共77例的临床资料。结果先天性食管闭锁及气管食管瘘为严重食管发育畸形,71例（92.2%）均行手术治疗,治愈47例（61.0%）,死亡30例（39%）。结论早期诊断和及时的手术治疗对提高先天性食道闭锁及食管气管瘘的治愈率有重要作用。     

先天性食管闭锁3例和先天性食管气管瘘2例临床分析

先天性食管闭锁和食管气管瘘在新生儿期并不罕见,国内发生率约1/20001/4000,占消化道发育畸形的第三位[1]。我院在19971999年共收住先天性食管闭锁3例,先天性食管气管瘘2例,现报告如下。临床资料1一般资料:5例均为足月儿,其中1例为足月小样儿,男1例,女4例。入院日龄为19小时13天。出生体重为1950ｇ3500ｇ,无出生窒息史,均由外院转入本院。母亲有羊水过多史3例。2症状及体征:生后不久即出现阵发性呼吸困难、发绀,唾液过多4例;生后1天内出现喂奶后呕吐、呛咳3例,下胃管困难4例,腹胀2例,并发呼吸衰竭、心力衰竭3例;肺部闻及湿罗音2例,入院后行…     

金属带膜支架治疗恶性食管支气管瘘的临床研究

食管气管瘘多因食管癌溃疡穿通或放疗损伤所致，一旦发生，预后极差，死亡率高。以往采用手术修补或保守治疗效果均较差。随着介入放射学的发展，金属支架治疗食管病变日益广泛，我院应用金属带膜支架治疗食管支气管瘘24例，报告如下。     

先天性食管闭锁手术治疗体会

目的 总结12例先天性食管闭锁手术治疗经验.方法 总结12例食管闭锁及气管食管瘘的一期吻合治疗经验,12例均采用胸膜外入路,5例需作近端食管肌层切开延长,施行瘘管结扎、切除端侧吻合2例.结果 存活9例,出现吻合口漏1例,死亡2例.结论 早期诊治、重视围手术期呼吸管理及营养支持,选择恰当术式和精细操作仍然是目前提高先天性食管闭锁治愈率的关键.     

纤支镜用于食管-气管瘘的诊治

随着新材料、新技术的不断发展并用于临床,纤维支气管镜(纤支镜)在疾病诊断与治疗中的应用日益广泛,特别是一些以往需采用复杂的手术治疗的疾病,目前有可能通过纤支镜进行处理。我科近2年来采用镍钛记忆合金(Ni-Ti shape memoryalloys,NT-SMA)支架、快速医用吻合OB胶(简称OB胶)、高频电凝术等治疗食管-气管瘘18例,取得了较好的疗效,现分析报告如下。     

可回收自膨防返流覆膜食道支架治疗食道贲门失弛缓症

目的探讨国产可回收自膨防返流覆膜食道支架在治疗食道贲门失驰缓症的临床应用。方法支架为南京微创医学科技有限公司产MTN-S型形状记忆镍钛合金可回收自膨防返流覆膜杯口球头食道支架,规格80/20mm(长度/直径),交替导丝,超硬导丝,导管,支架回收器。23例患者,钡餐确诊,最大年龄64岁,最小15岁,男性19人,女性4人。病程最长29年,最短12个月。狭窄程度1.0～5.0mm。在电视透视下,将导丝置入胃内(较困难者在胃镜帮助下置入导丝),沿导丝将置入器缓慢送入,支架远端置于胃内,近端在狭窄上方,开始释放,取出导丝和置入器,将回收线拉紧经鼻腔固定于耳廓上。两周时取出并复查钡餐。结果全部病例支架置入一次成功,术后感胸骨后钝痛,持续5～7d,用止痛药能缓解。有1例术后3d支架移入狭窄上方食道内,有2例分别于术后7d和12d滑入胃内,取出支架后重新置入。有1例患者术后1h出现恶心呕吐、疼痛性休克,经抢救无生命危险。所有病例两周时能顺利取出支架,未出现支架嵌顿现象,食道钡餐示狭窄有不同程度开放,达到15mm左右,解除了咽下困难。术后3个月、6个月、12个月钡餐或电话随访,最长者达43个月仍未出现咽下困难。结论支架扩张是随着支架进入体内后温度逐渐升高而扩张,作用于食道四周的力量均匀,疼痛轻微,不易引起食道破裂和出血,取出支架容易。该手术安全、简便、禁忌证少,由于国产支架大幅降低了费用,值得推广应用。     

Paclitaxel or 5-fluorouracil/esophageal stent combinations as a novel approach for the treatment of esophageal cancer

Currently, esophageal cancer is rarely curable, and herein, a paclitaxel or 5-fluorouracil/esophageal stent combination (PTX or 5-FU/stent) was used to provide a new approach to treat this cancer. The PTX or 5-FU/stent was prepared by covering a nitinol stent with a bilayered polymer film that consisted of a layer of 50% PTX or 5-FU and a layer of drug-free backing. These treatment modalities were evaluated in vivo after implantation into the porcine esophagus. The percentages of the drugs that permeated from the backing layer over a period of 95 days were very small (0.61% for 5-FU), and an overwhelming majority of the PTX and the 5-FU was released from the other side of the film. During the follow-up period (120 days), the drug/stent was always maintained in the porcine esophagus, and did not show any obvious systemic or local toxicities. In contrast, this treatment had an effect on the inhibition of tissue proliferation and ulceration. In addition, the drug concentrations were highest in the esophagus compared with in the heart, liver, spleen, lung, kidney and blood (81500.0 ± 9475.2 ng/g vs. 3.9 ± 0.3 ng/mL of PTX in the plasma at 13 days). The PTX/stent and the 5-FU/stent have a dual function as both a stent and a local drug delivery device, which provides a potential treatment modality with high efficacy and non systematic toxicity for esophageal cancer.     

Patterns of malformation associated with esophageal atresia/tracheoesophageal fistula: A retrospective single center study

Esophageal atresia/tracheoesophageal fistula (EA/TEF) is one of the most common gastrointestinal birth defects. It can occur in isolation or in association with other birth defects or genetic syndromes. We retrospectively reviewed the EA/TEF cases evaluated at Rady Children's Hospital San Diego (San Diego, CA) between 2007 and 2016. Data were collected for 157 patients. The majority of patients (105, 66.8%) had an associated major malformation present, and 52 patients (33.1%) had isolated EA/TEF. The patients with associated malformations were distributed as follows: 16 patients (10.2%) had a known genetic syndrome (the most common being Trisomy 21 in 11 patients); six patients (3.8%) had a suspected genetic syndrome; one patient had a suspected teratogenic syndrome (diabetic embryopathy); 30 patients had VACTERL association (19.1%); 32 patients had a “partial VACTERL” association (only two VACTERL‐type defects without other malformation); nine patients (5.7%) had one additional non‐VACTERL‐type birth defect, two patients had VACTERL‐type defects plus auricular malformations; and nine patients (5.7%) were classified as “unknown syndrome.” A classification of the patterns of malformation of patients with congenital EA/TEF is proposed based on reviewing the data of this relatively large and phenotypically diverse patient group.     

Management of esophageal stenting-associated esophagotracheal fistula,tracheal stenosis and tracheal rupture: a case report and review of the literature

Objective: Although the placement of esophageal self-expandable stents (SES) can effectively relieve dysphagia after radiotherapy in patients with esophageal cancer (EC), it may induce severe esophageal complications. This article reports a case of emergency endotracheal intubation in an EC patient who suddenly developed severe dyspnea two months after SES placement. Methods: Electronic bronchoscopy of the patient’s airway confirmed the diagnosis of esophagotracheal fistula, tracheal stenosis and tracheal rupture. Endotracheal intubation was successfully performed under the guidance of electronic bronchoscopy. Results: Dyspnea due to tracheal stenosis was relieved effectively by inserting the tracheal catheter to a proper place under the guidance of electronic bronchoscopy. Conclusion: Bronchoscopic examination is strongly recommended in EC patients who are highly suspected as having airway stenosis associated with esophageal stenting, for which endotracheal intubation under the guidance of bronchoscopy is suggested.     

Polymeric photosensitizer-embedded self-expanding metal stent for repeatable endoscopic photodynamic therapy of cholangiocarcinoma

Photodynamic therapy (PDT) is a new therapeutic approach for the palliative treatment of malignant bile duct obstruction. In this study, we designed photosensitizer-embedded self-expanding nonvascular metal stent (PDT-stent) which allows repeatable photodynamic treatment of cholangiocarcinoma without systemic injection of photosensitizer. Polymeric photosensitizer (pullulan acetate-conjugated pheophorbide A; PPA) was incorporated in self-expanding nonvascular metal stent. Residence of PPA in the stent was estimated in buffer solution and subcutaneous implantation on mouse. Photodynamic activity of PDT-stent was evaluated through laserexposure on stent-layered tumor cell lines, HCT-116 tumor-xenograft mouse models and endoscopic intervention of PDT-stent on bile duct of mini pigs. Photo-fluorescence imaging of the PDT-stent demonstrated homogeneous embedding of polymeric Pheo-A (PPA) on stent membrane. PDT-stent sustained its photodynamic activities at least for 2 month. And which implies repeatable endoscopic PDT is possible after stent emplacement. The PDT-stent after light exposure successfully generated cytotoxic singlet oxygen in the surrounding tissues, inducing apoptotic degradation of tumor cells and regression of xenograft tumors on mouse models. Endoscopic biliary in-stent photodynamic treatments on minipigs also suggested the potential efficacy of PDT-stent on cholangiocarcinoma. In vivo and in vitro studies revealed our PDT-stent, allows repeatable endoscopic biliary PDT, has the potential for the combination therapy (stent plus PDT) of cholangiocarcinoma.     

可分解食道支架缝合线体外降解性能的研究

采用磷酸盐缓冲溶液(PBS)(pH=7.4)为降解介质,37℃下对可分解食道支架聚(L-丙交酯)(PLLA)和聚(乙交酯-丙交酯)(PGLA)缝合线进行8周的体外降解实验。通过测试降解过程中其质量损失、pH值、特性粘度、抗张强度、取向度、结晶度、熔点及表面形貌等变化情况,对其体外降解行为进行研究。结果表明PLLA缝合线各项性能无明显变化,而PGLA缝合线各项性能发生了显著变化。随着降解进行PGLA缝合线的pH值、特性粘度、抗张强度、取向度和结晶度逐渐下降,质量损失率增加,6周时抗张强度几乎为零,8周时质量损失率近70%。DSC结果表明,随着体外降解PGLA缝合线晶区熔点保持不变,晶区的熔融热焓逐渐增加,而无定形区产生新的有序区.并且含量不断增加。SEM结果表明PGLA缝合线在降解过程中,涂层首先脱落,然后线体以横向断裂方式断裂。因此,PGLA缝合线适用于良性食道狭窄的可分解食道支架,而PLLA缝合线制备的支架分解时间大于2个月,不适于良性狭窄的治疗。     

Evidence of a common pathogenesis for foregut duplications and esophageal atresia with tracheo‐esophageal fistula

The pathogenesis of the alimentary tract duplications, including foregut duplications (FgD) remains speculative. The accidental finding of FgD in fetal rats with esophageal atresia and tracheoesophageal fistula (EA‐TEF) induced by Adriamycin provided an animal model to investigate a possible relationship between these two entities. Timed‐pregnant rats were intraperitoneally injected with Adriamycin (1.75 mg/kg) on gestational Days 6 to 9. Their embryos were harvested by Caesarean section from gestational Days 14 to 21. Forty‐six of embryos were processed and serially sectioned in the transverse or sagittal planes. EA‐TEF occurred in 43/46 (93%) embryos of which 11 (24%) were found to have an associated FgD located at the level where the esophagus was absent. Six FgDs communicated with the foregut or the trachea. Five noncommunicating FgDs were located between the foregut and the vertebral column. In the control embryo, the notochord was located in the centre of the vertebral column from Day 11 of the gestation. In Day 14, 15 and 16, however, embryos exposed to Adriamycin, an abnormal notochord or branch frequently was located within the mesenchyme of the maldeveloped foregut or attached to the duplication cyst. In some, it appeared that the notochord was drawing the cyst‐like structure away from the foregut. The present study confirms that duplications adjacent to the esophagus arise from the foregut and that failure of the foregut to detach from the notochord at the normal time may contribute to the development of foregut duplications. Anat Rec 264:93–100, 2001. © 2001 Wiley‐Liss, Inc.     

新型可回收血管支架的设计与有限元分析

目的针对药物洗脱支架植入后引起的早期再狭窄问题,对镍钛合金血管支架进行结构上的可回收设计和生物力学分析。方法建立可回收血管支架及其回收系统的几何模型,其中支架回收部为圆台形网状结构,由4个对称分布的回收筋组成;分析支架在压握过程中的最大主应变分布、压握及自膨胀均匀性等,并对支架的回收过程进行仿真实验。结果当支架被压握至最小尺寸时,其最大应变为3.7%,不均匀性指数为0.62%;当支架自膨胀结束时,其不均匀性指数为1.31%;当1/2支架被回收进外鞘管时,最大应变为1.52%;而支架在回收过程中并未发生断裂或"卡顿"情况。结论支架应变在其安全范围之内,且支架的压握及自膨胀过程较均匀,能够被安全、顺利地回收进外鞘管中。研究结果可以为可回收血管支架的结构设计、生物力学分析和临床应用提供重要参考依据。     

Cerebral arterial air emboli after stent insertion in esophageal cancer complicated with esophago‐left atrial fistula: An autopsy case and review of the literature

Cerebral arterial air embolism is a rare and unexpected complication of advanced esophageal cancer. The entry of air to systemic circulation is an esophago‐left atrial or pulmonary vein fistula formation. Herein, we report an autopsy case of a 64‐year‐old man. He was diagnosed esophageal cancer 2 years ago and underwent chemotherapy and concurrent chemoradiotherapy but the disease progressed, unfortunately. Then two metal stents were inserted into the middle thoracic esophagus as a palliation of dysphagia. After initiation of oral intake, he developed deterioration of consciousness. The cranial computed tomography showed cerebral arterial air emboli with multiple low‐density areas. He failed to gain consciousness again and died one and half days later. In a literature survey, this autopsy case is the first presentation that confirmed histologically the close association between stent placement and formation of esophago‐left atrial fistula. Due to the fatality of cerebral arterial air embolism, clinicians should keep in mind the possibility of this catastrophic complication after multimodality treatment of esophageal cancer.