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The Clinical Aplication and Efficacy of Domestic Self-expanding Nickel-titanium Memorial Alloying Covered Stent

目的：探讨国产自膨式镍钛记忆合金食管支架在食管、贲门良恶性狭窄及食管瘘中的临床应用并观察疗效。方法:收集我院2005年11月～2008年8月采用胃镜辅助置入镍钛记忆合金食管支架的患者108例，其中男90例，女18例，年龄37~88岁；包括食管癌性狭窄41例，贲门癌性狭窄5例，放疗后狭窄1例，肺癌压迫致食管狭窄1例，食管、贲门癌术后吻合口顽固性狭窄21例，食管癌术后复发致狭窄6例，食管瘘33例。结果：108例患者共置入食管支架116枚，一次性置入成功率100%，置入后患者吞咽梗阻的症状有不同程度的改善，呛咳的症状基本消失。结论：食管支架置入操作简单、安全，成功率高，是治疗食管良恶性狭窄及封堵瘘口的有效方法。

Surgical Intervention of Iatrogenic Tracheobronchoesophageal Fistula

Abstract： Objective To investigate the cause and treatment of iatrogenic tracheobronchoesophageal fistula and provide experiences for clinic treatment. Methods Between January 1995 to December 2008, 21 patients with tracheobronchoesophageal fistula were treated in Shanghai Chest Hospital and Shanghai 6th Hospital. Among them, iatrogenic fistula happened in 12 patients including 8 males and 4 females whose age ranged from 35 to 74 years old with an average age of 47. Fistula developed 21 d to 5 years after the treatment of the primary diseases which were mainly tumors. Two of them developed tracheoesophageal fistula, 10 bronchoesophageal fistula; 6 right bronchoesophageal fistula, and 4 left bronchoesophageal fistula. Fistula excision and surgical repair of the tracheobronchoesophageal fistula were performed on 2 patients; Lung lobectomy and repair of the esophageal fistula were performed on 5 patients; Tracheal fistula repair and pneumonectomy with reconstruction of the digestive tract were done on the rest 5 patients. Results No operative death occurred. Postoperative complications in 2 cases were cured without recurrence. In the 1year followup to all the 12 patients, no recurrence of fistula occurred. Conclusion Iatrogenic tracheobronchoesophageal fistula is a complex and severe disease for which surgery is the only best treatment.

应用带膜镍钛记忆合金支架治疗晚期食管癌

目的总结应用带膜镍钛记忆合金支架治疗晚期食管癌的临床经验。方法53例晚期食管癌患者在食管X线钡餐透视下采用介入法、内镜法或术中植入法在食管内放置带膜镍钛记忆合金支架。术后进食困难程度用Neuhaus分级评估，并随访观察所有患者近期和远期疗效。结果所有患者支架均一次放置成功，无操作引起的严重并发症，术后患者吞咽困难症状明显改善，置入支架后患者吞咽困难分级较置入支架前明显降低（P〈0．01），能顺利进半流质或普通食物。狭窄食管段直径由2～4mm扩张至16～20mm。随访49例（92．5%），随访时间3～24个月。术后近期并发症主要为胸骨后异物感、疼痛、恶心和少量消化道出血，发生率为96．2％（51／5a）。26例患者（53．1％，26／49）于术后3～15个月内死亡，平均生存7．8个月，死亡原因多为肿瘤转移、全身衰竭。结论食管内放置带膜镍钛记忆合金支架治疗晚期食管癌患者的食管狭窄、食管瘘简单易行、损伤小，近期疗效明显，是一种有效的姑息性非手术治疗方法。

Clinical efficacy of stapler technique for repair of cervical tracheoesophageal fistula

Objective To evaluate the clinical efficacy of fistula repair by stapler technique in patients with cervical tracheoesophageal fistula. Methods Retrospective analysis of 8 patients with cervical tracheoesophageal fistula who accepted operative treatment in the Department of Thoracic Surgery, Lanzhou University Second Hospital from October 2014 to October 2016 was conducted. There were 5 males and 3 females at a mean age of 46.4±13.9 years ranging from 23 to 67 years. The fistula was induced by tracheal intubation in 4 patients, by esophageal foreign bodies in 2, by tracheal stent in 1 and by esophageal diverticulum in 1. The fistula was closed by stapler technique. The surgical effects were evaluated through Karnofsky performance score (KPS), image assessment, patient satisfaction score and assessment of improvement in feeding-induced bucking. Results The operations were performed successfully with time of 117.5±6.6 min and intraoperative blood loss of 60.0±7.0 ml. After the operations, the patients did not suffer incision bleeding and infection, hoarseness, dyspnea, drinking-induced bucking, fistula relapse, tracheoesophageal stenosis or any other complications, and no death occurred during the perioperative period. The chest X-ray test was performed 1 week later showed that the pulmonary infection disappeared, and only 1 patient suffered from esophageal stenosis 1 year later. The postoperative KPS score was 90.0±7.0 points, which significantly improved in contrast to preoperation (P<0.01). Postoperative pulmonary infection area reduced significantly (P<0.05), tracheoesophageal fistula disappeared, postoperative patients satisfaction rate was 90%, and assessment of feeding-induced bucking was excellent. Conclusion Using stapler technique to repair cervical tracheoesophageal fistula is safe, easy and useful, with less operation time and postoperative complications.

重症烧伤并呼吸道吸入性损伤作气管切开致气管食管瘘一例

食管瘘治疗新进展

食管瘘是指各种原因所致食管与邻近器官的异常交通，根据瘘口连通的部位可分为食管胃吻合口瘘、食管气管瘘、食管纵隔瘘、食管胸腔瘘、食管主动脉瘘等，其中食管主动脉瘘相对较少见。食管瘘发生后消化道分泌物甚至食物可经过瘘口进入气管、胸腔、纵隔等，常导致致命性感染，且感染较难控制，若食管瘘不能得到及时诊治，常导致多器官功能衰竭甚至死亡。因此食管瘘的治疗成为胸外科和消化内科医生研究的热点之一。近年随着内镜技术的不断发展，食管瘘的内镜治疗取得良好的效果。现就食管瘘治疗的方法、效果等作一综述。

支气管镜联合消化内镜成功治疗食管癌术后气管食管瘘和胃底胸膜瘘一例

目的 探索气管食管瘘及胃底胸膜瘘的临床救治方法。方法 回顾分析我院呼吸与危重症医学科经支气管镜联合消化内镜成功治疗食管癌术后气管食管瘘和胃底胸膜瘘1例。结果 患者男，64岁，因“进食后胸痛3周余”于2021年6月21日入胸外科，23日胃镜示食管中段新生物，病理为中分化鳞癌，25日行胸腔镜下右胸腹两切口食道癌根治术。术后第4天患者出现胸痛伴发热，7月5日胸部CT示左侧液气胸，胸腔镜探查术置管引流后脱机困难，10日转入呼吸与危重症医学科，数字减影血管造影下介入和气管镜检查明确诊断气管食管瘘和胃底胸膜瘘，保守治疗1个月效果不佳，经多学科讨论后先行气管镜引导下气道Y型覆膜支架植入封堵术，后行胃镜下氩离子束凝固术烧灼+气管食管瘘和胃底胸膜瘘钛夹夹闭术。患者术后痰量减少，无发热，复查CT两肺感染和胸腔积液明显吸收，消化道造影未见钡餐外溢现象，患者顺利脱机堵管，拔除气切套管后康复出院，门诊随访病情稳定。结论 食管癌术后短期内同时出现气管食管瘘和胃底胸膜瘘，实属罕见，救治难度较大。该患者的成功救治说明支气管镜联合消化内镜是治疗气管食管瘘和胃底胸膜瘘的有效方法，值得借鉴和推广。

新生儿先天性食管闭锁/气管食管瘘麻醉策略的改进

内镜下置覆膜镍钛合金支架治疗食管瘘的护理

【摘要】 目的 探讨内镜下放覆膜镍钛合金支架治疗食管气管瘘、食管纵隔瘘的疗效及护理。 方法 对2001年1月-2009年3月收治的56例食管气管瘘、食管纵隔瘘患者，行内镜下置入覆膜记忆合金支架封堵瘘口的术前、术中、术后护理观察及疗效随访。 结果 所有患者均一次置放成功，瘘口全部封闭，无一例因为护理及饮食不当而导致失败。 结论 内镜下放覆膜镍钛合金支架是治疗食管气管瘘、食管纵隔瘘一种安全、有效、简便方法，能达到封闭瘘口，恢复进食，控制肺部感染，改善患者生活质量的目的。

Research progress of endoscopic vacuum-assisted closure therapy for esophageal fistulas

How to effectively repair esophageal fistulas, caused by esophageal perforation, rupture and anastomotic leakage after esophagectomy has always been a key problem for the digestive surgeon. Although there are many clinical treatment methods, the therapeutic effect is still completely unsatisfactory, especially when severe mediastinal purulent cavity infection is associated with the esophageal fistula. In recent years, foreign centers have promoted a new minimally invasive endoscopic treatment technology to repair the esophageal fistula, endoscopic vacuum-assisted closure therapy, with significantly curative effect. In this article, we will review the specific operation, advantages and disadvantages, as well as the clinical efficacy of endoscopic vacuum-assisted closure therapy in treating the esophageal fistulas, to provide a new therapeutic technique for esophageal fistulas and expand the new field of minimally invasive endoscopic therapy.