个体化全覆膜支架封堵食管-胃吻合口瘘、胸腔胃-气道瘘、化学灼伤后食管瘘

目的探讨个体化可取式覆膜支架，封堵食管-胃连接部吻合口瘘和胸腔胃-主支气管瘘及化学灼伤后食管瘘的治疗方法及临床价值。方法667例上消化道良、恶性病变支架植入病例中，食管-胃吻合口瘘63例，胸腔胃－气道瘘11例，化学灼伤后食管瘘17例。瘘口直径0．5～2cm。瘘口部位：食管－胃颈部吻合口瘘7例，食管－胃胸腔内吻合口瘘33例，食管－胃膈下吻合口瘘23例；胸腔胃－右主支气管瘘9例，胸腔胃－气管隆突瘘2例；化学灼伤后食管上段瘘3例，中段瘘9例，下段瘘5例。均在DSA透视下经口腔植入支架，依据残胃大小及瘘口位置，选定下端为大喇叭口径可取式覆膜支架63枚；气管-支气管分叉型全覆膜支架11枚；全覆硅胶膜长管状“Z”型支架18枚。结果63例食管-胃吻合口瘘及11例胸腔胃-气道瘘和17例化学灼伤后食管瘘，共植入支架92枚。支架植入后分别于2、7、12、17、22、30d，口服碘水DSA下透视检查，所有病例均堵瘘成功。支架取出无一例消化道出血、食管破裂、瘘口复发等并发症出现。结论设计个体化可取式覆膜支架，封堵食管-胃连接部吻合口瘘和胸腔胃-气道瘘及化学灼伤后食管瘘临床疗效肯定，具有临床推广应用价值。

Individual full covered stents block gastroesophageal anastomosis fistula,thoracostomach-trachea fistula and chemical burned esophagus fistula

Objective To study the method and clinical value of blocking gastroesophageal anastomosis fistula, thoracostomach-main bronchus fistula and chemical burned esophagus fistula with individual recalled covered stent. Methods The stent was implanted in 667 cases of benign and malignant esophagus fistula, of which 63 cases were gastroesophageal anastomosis fistula, 11 cases thoracostomachtrachea fistula and 17 cases chemical burned esophagus fistula. The diameter of fistula extended from 0.5 cm to 2 cm. The fistula site：7 eases were gastroesophageal fistula at cervix,33 at thorax and 23 under midriff; 9 cases were thoracostomach-right bronchus fistula ,2 eases apophyseal trachea fistula ;3 cases were chemical burned esophagus fistula at upside ,9 at middle part and 5 underside .Under the DSA fluoroscopic guidance ,stent was implanted through mouth. According to the size of the rudimental gaster and the position of the fistula, we selected 63 recalled covered stents whose inferior looked like a big trumpet caliber ;11 trachea-bronchial full covered stents which ramified ;18＂Z＂-typed stents full covered with silica gel. Results For 63 anastomosis fistula, 11 thoracostomach-trachea fiatula and 17 chemical burned esophagus fistula ,92 stents in all were implanted .On 2,7,12,17,22,30 days after implantation, took iodine water and fluoroscoped under the DSA. All fistula were blocked successfully. No complication such as bleeding in enteron, collapse of esophagus or relapse of fistula happened when the stents were recalled. Conclusion The technique of individual recalled covered stents designed to block the fistula is effective and is worthy of clinical application and popularization.