食管胃吻合口瘘的内支架治疗

目的 评价国产带膜金属内支架治疗食管胃吻合口瘘的临床效果。材料和方法 本组１８例，食管下段癌１５例，贲门癌３例，选用２国产镍钛热记忆合金带膜支架与自工不锈钢丝“Ｚ”型带膜支架（ＣＥＳ）。支架一电视监视下进行１４例，于胃镜直视下进行４例，术后给予抗生素、止血药及镇静止药。结果 １８例支架国入术成功率１００％瘘，瘘口安全封堵，第２，３天即能进半流质或普食，随访１月－１年，全部存活，无１例支架滑脱，结论     

X线或胃镜下置入鼻肠管治疗食管癌术后吻合口瘘6例

食管胃吻合口瘘是贲门以上食管癌术后常见并发症。在X线或胃镜引导下,置入鼻肠管不仅可明确吻合口瘘的部位、大小,还可有效解决肠内营养。2010年8月-2012年10月,我们共收治食管癌术后吻合口瘘6例,均在x线或胃镜引导下,置入鼻肠管行肠内营养支持,效果满意。现分析报告如下。     

经鼻空肠管带膜支架序贯治疗自发性食管破裂

目的 研究鼻空肠管、带膜支架序贯治疗自发性食管破裂的疗效.方法 10例自发性食管破裂中,男9例,女1例,破裂部位位于中段3例,食管下段7例;破口长3～7 cm.对本组病人,在胃镜直视下经导丝将鼻引流管从食管瘘口放进纵隔的脓腔内,并安置带体外回收线的覆膜内支架,然后经导丝安置鼻空肠管进行肠内营养;继之,鼻引流管冲洗脓腔与负压吸引交替进行,待胸腔闭式引流液基本转清,拔出鼻引流管;此后,如X光造影剂或口服美蓝无渗漏,撤除鼻空肠管改经口进食,置入支架大约6～12 w;如胸腔闭式引流管无引流液流出,拔出支架,造影无渗漏,继续进食,观察2～3 d;如胸腔闭式引流仍无引流液流出,拔胸腔闭式引流管.结果 本组病人经安放鼻引流管、带膜支架、鼻空肠管等序贯疗法,9例痊愈出院（治愈率90%）,死亡1例（病死率10%）.9例出院患者均随访6～24个月,平均18个月,饮食生活恢复正常,未出现远期咳嗽、气紧、吞咽梗阻等并发症.结论 经胃镜置支架及鼻引流管、空肠管序贯治疗、自发性食管破裂安全、方便、效果良好.     

蘑菇状覆膜内支架的设计和在食管胃吻合口-胸腔瘘中的应用

目的 设计封堵食管胃吻合口-胸腔瘘的覆膜内支架。方法 根据食管胃吻合口区的特殊解剖结构和吻合口胸腔瘘的病变特点，设计蘑菇状覆膜内支架。透视下，5例吻合口巨大胸腔瘘患者置入6枚蘑菇状覆膜内支架。结果 蘑菇状覆膜内支架能有效封堵食管胃吻合口巨大胸腔瘘，解决了进食问题，改善了营养状况。结论 蘑菇状覆膜内支架结构设计合理，操作简单、安全，近期疗效明显，是一项值得推广的新技术。     

可取性金属内支架治疗食管良性狭窄和食管-胃吻合口瘘

目的：探讨国产可取性金属内支架治疗食管良性狭窄和瘘的疗效及介入技术。方法：1998年至2003年对14例食管良性狭窄、8例食管--胃吻合口瘘患采用可取性金属内支架治疗，观察疗效及并发症j结果32个支架一次性释放成功，31个支架顺利取出，无严重并发症，20／22例食管狭窄段由3mm～8mm增宽至12mm以上，观察3个月～15个月，能进软食或普食，吻合口瘘闭合。结论：国产CZES型可取性全被覆膜金属内支架，较长的置入时间，明显提高了食管良性狭窄和瘘的治疗效果。     

金属内支架治疗食管上段良恶性狭窄及食管-胃吻合口瘘

我院自 2 0 0 0年 7月～ 2 0 0 1年 7月对 6例食管上段 (相当于胸 1～胸 4椎体高度 )良恶性狭窄、食管胃吻合口瘘、结肠代食管结肠胃吻合口胸腔瘘行支架置入术治疗 ,现将有关资料及治疗效果报道如下。材料与方法本组 6例均为男性 ,年龄 5 4～ 6 3岁 ,平均年龄5 8岁。均有吞咽困难 ,合并气管瘘的患者饮流质时明显呛咳 ,消化道碘水、钡餐及胃镜检查均见食管上段狭窄及食管胃吻合口狭窄 ,碘水造影可见瘘口大小及走行。食管胃吻合口肿瘤复发狭窄合并气管瘘2例 ,食管胃吻合口瘢痕狭窄 2例 ,结肠代食管结肠胃吻合口胸膜腔瘘 1例 ,食管癌性狭窄 1例…     

双支架（覆膜）治疗食管胃胸内吻合口瘘

目的：探讨双（覆膜）支架治疗食管-胃胸内吻合口瘘的疗效及操作方法。方法：回顾分析9例接受覆膜支架治疗食管-胃胸内吻合口瘘患者的临床资料。结果：9例患者,共植入9个双喇叭口自膨式镍钛记忆合金覆膜食管支架和8个覆膜针织支架。8例植入双支架的患者瘘口均达到完全封堵,另1例患者只放置1个覆膜食管支架的,术后1周造影发现经支架上口边缘仍有少许对比剂进入瘘口,给予保守治疗瘘口愈合。术后有5例患者出现胸骨后隐痛,1周后自动缓解。结论：双覆膜支架能完全封堵瘘口,安全有效。     

国产自膨式带膜支架治疗食管-胃吻合口瘘的疗效

目的评价国产食管带膜支架治疗食管癌术后食管—胃吻合口瘘的效果。方法15例手术切除病变食管行食管-胃吻合术后,经钡餐或碘水造影证实为吻合口瘘的患者,进行了经口植入国产食管带膜支架瘘口封堵治疗。结果所有支架均一次性成功植入,共植入17枚支架,即时堵瘘100%,支架植入后3～5d再发瘘2例(13.3%),支架移位1例(6.6%)。未见严重并发症。结论国产食管带膜支架治疗食管癌术后食管-胃吻合口瘘安全、有效,是重要的治疗手段。     

胸腔引流,空肠逆行置胃管及空肠造瘘治疗食管胃吻合口瘘

目的为探讨治疗食管癌、贲门癌术后吻合口瘘并发症的方法。方法行胸腔引流、空肠逆行置胃管及空肠造瘘,同时给予应用抗生素及支持治疗。结果接受胸腔引流、空肠逆行置胃管及空肠造瘘治疗的患者,全部治愈出院。结论胸腔引流、空肠逆行置胃管及空肠造瘘在对食管癌、贲门癌术后吻合口瘘的治疗中,取得了较好的疗效,值得推广。     

支架置入与引流管置入治疗恶性胆肠吻合口狭窄的对比研究

目的比较自膨胀金属支架（SEMS）置入与引流管置入治疗恶性胆肠吻合口狭窄（BAS）的疗效和安全性。 方法回顾性分析2016年3月至2019年6月期间接受治疗的33例恶性BAS患者。其中19例患者接受了SEMS（支架组）治疗，其余14名患者接受了引流管置入治疗（引流管组）。技术成功定义为将支架或引流管成功放置在适当的位置；临床成功定义为术后1周内血清胆红素与基线水平相比降低20％。比较两种治疗方法的并发症，支架或引流管的通畅时间和总体存活率。 结果两组患者均取得了技术成功。在支架组中，15名患者放置了1个支架，另外4名患者放置了2个支架。两组的临床成功率相似，支架组94.7％（18/19），引流管组92.9％（13/14）。两组均没有严重并发症。支架/引流管的中位通畅时间支架组（130 d）显著长于引流管组（61 d，P=0.001）。支架组（159 d）的中位生存期也明显长于引流管组（65 d，P=0.003）。 结论支架置入治疗恶性BAS支架通畅时间和患者存活期显著长于引流管置入治疗恶性BAS，SEMS放置可能优于引流管置入。     

透视下双导丝置管法在食管癌术后吻合口瘘治疗中的应用

目的 探讨透视下双导丝置管法在食管癌术后吻合口瘘患者置管及治疗中的应用价值.方法 12例食管癌手术切除术后出现吻合口瘘的患者,在透视下采用双导丝引导经鼻分别置入十二指肠营养管和胃肠减压管,统计其技术成功率、平均置管时间、并发症以及吻合口愈合情况.结果 所有患者均成功置入十二指肠营养管和胃肠减压管,技术成功率为100%.单个患者置管时间为5～8 min,平均6min.操作及置管使用过程中未出现心律失常、误插、吸人性肺炎、会厌功能紊乱等并发症.10例治愈,愈合时间为17～37 d,平均28 d.2例死亡.结论 透视引导下双导丝置管法操作简单、安全、成功率高,置入十二指肠营养管和胃肠减压管可提高食管癌术后吻合口瘘的治愈率.     

Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage

Objective

The aim of this study was to retrospectively evaluate the technical success rates and clinical effectiveness of fluoroscopically guided nose tube drainage of mediastinal abscesses and a nasojejunum feeding tube in post-operative gastro-oesophageal anastomotic leakage (GEAL).

Methods

From January 2006 to June 2011, 18 cases of post-operative GEAL with mediastinal abscesses after oesophagectomy with intrathoracic oesophagogastric anastomotic procedures for oesophageal and cardiac carcinoma were treated by insertion of a nose drainage tube and nasojejunum feeding tube under fluoroscopic guidance. We evaluated the feasibility of two-tube insertion to facilitate leakage site closure and complete resolution of the abscess, and the patients’ nutritional benefit was also evaluated by checking the serum albumin level between pre- and post-enteral feeding via the feeding tube.

Results

The two tubes were placed successfully under fluoroscopic guidance in 18 patients (100%). The procedure time for two-tube insertion ranged from 20 to 40 min (mean 30 min). 17 patients (94%) achieved leakage site closure after two-tube insertion and had a good tolerance of two tubes in the nasal cavity. The serum albumin level was significant, increased from pre-enteral feeding (2.49±0.42 g dl⁻¹) to the post-enteral feeding (3.58±0.47 g dl⁻¹) via the feeding tube (p<0.001). The duration of follow-up ranged from 1 to 49 months (mean 19 months).

Conclusion

The insertion of nose tube drainage and a nasojejunum feeding tube under fluoroscopic guidance is safe, and it provides effective relief from mediastinal abscesses in GEAL after oesophagectomy. Moreover, our findings indicate that two-tube insertion may be used as a selective procedure to treat mediastinal abscesses in post-operative GEAL.

Advances in knowledge

Directive drainage of mediastinal abscesses in post-operative GEAL may be an effective treatment.Mediastinal leakage occurs in about 7% of distal oesophageal resections and is associated with a mortality rate of up to 60% [1,2]. Although the amounts of post-operative anastomotic leakage can be rather slight, the leakage is a major source of mortality and morbidity [3]. The leading causes of death in patients with mediastinal abscesses are infection and nutritional deficiency [4,5]. Mediastinal abscesses form a potentially devastating condition in gastro-oesophageal anastomotic leakage (GEAL). Historically, intravenous antibiotics combined with surgical debridement have been the mainstay of therapy [6]. Rethoracotomy extended procedure, however, carries considerable risks for a critically ill patient [5]. Han et al [7] treated patients with mediastinal abscess with stent placement and nasal–oesophagal drainage, while percutaneous drainage was applied under the guidance of CT [8,9] or endoscopy [10,11]. Drainage may be a promising treatment for mediastinal abscess in GEAL. In this study, we determined the feasibility and effectiveness of using two-tube insertion under fluoroscopic guidance in the treatment of mediastinal abscess in GEAL. The effect of treatment was evaluated by time interval of the leaks’ closure and the effect on nutritional status was evaluated by serum albumin level.     

Balloon dilatation and stent placement of suprahepatic caval anastomotic stenosis following liver transplantation

We present an unusual case of suprahepatic caval anastomotic stenosis after adult liver transplantation in the early postoperative period. Color flow Doppler sonography and cavography were used to confirm the clinical diagnosis. Success-ful nonoperative treatment of the obstruction was achieved by balloon dilatation and subsequent implantation of a vascular stent.     

X线透视下经鼻十二指肠营养管的置入及临床应用

目的探讨X线透视下十二指肠营养管的置入及其临床应用价值。方法从2003年6月3日至2007年8月17日,59例患者在X线透视下行经鼻十二指肠营养管置入,置管成功后营养管末端位于十二指肠空肠连接部。结果59例患者中首次成功放置空肠营养管57例,成功率96.6%,2例患者因明显胃扩张首次置管失败后在充分胃肠减压后置管成功。置管时间为3.9～68.6 min,平均17.8 min。置管中及置管后未发生严重并发症。结论X线透视下经鼻十二指肠营养管置入是一种安全、经济、有效的肠内营养途径,因而具有广泛的临床应用价值。