| Background and purpose Thoracic stomach-tracheal/bronchial fistula is one of the common complications of esophageal cancer surgery,because of its complexity,it is difficult to deal in clinical treatment,affected by the tumor recurrence,persistent infection,physical limitations of fistula patients,and many other factors.The clinical efficacy of these complications are poor in both internal and surgical treatment,the higher the mortality rate,usually with high mortality.In recent years,with the development of new interventional radiology techniques,benefit from advances in new techniques for implantation of stents in the airways and improvement of stents materials and techniques,despite the inability to use stents for the highly variable gastric cavities,However,relevant scholars have successfully tried to implant the stent into the airway.Following with the continuous maturation of interventional techniques,tracheal or bronchial stents are more and more widely used in clinical practice,according to the anatomical characteristics of thoracic stomach and tracheal / bronchial surgery after surgical resection,we designed and clinically applied airway covered stent to occlude the thoracic gastric-trachea / bronchial fistula then retrospectively analyzed the clinical efficacy of airway covered stent in 110 patients.Materials and methods1.110 cases patients with thoracic stomach-tracheal / bronchial fistula from November 2001 to June 2015 consecutive patients were collected as research group,treated with airway covered stent implantation to plug fistula.The control group also selected 102 cases of esophageal cancer patients who had been diagnosed as thoracic stomach-tracheal fistula(bronchial fistula),without any clinical medicine interference,only routine care.All of them were diagnosed by chest SCT,upper gastrointestinal imaging,endoscopy or fiber bronchoscopy.There was no statistically significant in the comparison of general information between the two groups of patients.2.All the patients were implanted nasal jejunal tube and gastrointestinal decompression in research group,to keep nutrition maitance and suction of gastric juice;Foods and water are prohibited for all patients before surgery,intrajejunal nutrition tube infusion fish soup,chicken soup and other nutrients;Continuous gastrointestinal decompression,in order to earn more time for the closure surgery.Based on the results of detection about fiberoptic bronchoscopy,DSA airway angiography and thoracic CT,the individual stomach-tracheal / bronchial fistula occlusion stent was developed.Under the guidance of DSA,the corresponding stent was placed in the patient's airway fistula position.Then observe the success rate of stent implantation,fistula occlusion and short-term survival rate and long-term quality of life in patients.3.A retrospective case-based study was performed to analyze the disease progression,complications control,short-term,mid-term,long-term survival and mortality quality of life assessment and overall health status in patients of both groups,.In order to evaluate the clinical efficacy of thoracic gastric-airway fistula occlusion of the airway covered stent.Result1.The experimental group: A total of 137 pieces of airway covered stents were implanted in the 110 patients,including 23 pieces of long tubular full airway covered stents,54 pieces of Y-shaped airway covered stents,26 pieces of small Y-shaped airway covered stents,17 pieces of double Y-shaped airway covered combination stents.The study found that 110 patients who were implanted in the corresponding airway stent,DSA angiography found that the fistula were effectively blocked by implantation in the corresponding airway stents in the 110 patients,data indicates a one-time operation success rate of 90.0%.Results of follow-up: short-term follow-up within 1 month after stents implantation showed that the clinical symptoms of 95 patients in the study group were improved to different extents,the fistulas were effectively blocked,and the overall quality of life was significantly improved.Stents were displaced in 9 patients with thoracic gastric-bronchial fistula,after re-implant of the stents,the symptoms were relieved;6 patients had severe pulmonary infection and died of body failure when the stent placed about 25 days.Followed up for 1~24 months,4 patients lost to follow-up,the lost rate was 3.6%.The survival rate was 84.5% within 3 months after stents implatation,the one-year survival rate was 67.3% and the two-year survival rate was 53.6%.Analysis of the causes of death in two years: 51% of patients died of body failure,35.3% of patients died of persistent respiratory infection,7.8%of patients died of cachexia,5.9% of patients died of massive hemoptysis,asphyxia.Patients overall quality of life assessment results significantly improved.2.Results of follow-up in control group: a short-term follow-up within a month showed that 102 patients with symptoms increased in varying degrees,34 patients with severe pulmonary infection,hemoptysis obvious symptoms;12 cases of patients with pleural effusion and serious tumor infection,patients are going to death;7patients died of respiratory failure around the 25 th day of observation.Follow-up for 1 to 24 months,lost 7 peoples,the lost rate of was 6.8%,the survival rate of patients within 3 months was 67.6%,the one-year survival rate was 23.5% a year,the two-year survival rate of 10.8%.Two years of patient mortality statistics showed that90.9% of patients died of persistent respiratory infection caused by respiratory failure,3.8% died of malignant tumor invasion,5.3% died of massive hemoptysis or other complications.Patients overall quality of life assessment results decreased.3.The nasal jejunal tube decompression and gastric tube placement in patients significantly lowered cough symptoms in patients of research group.Compared with the patients in the control group,electrolyte imbalance was mild than the one in the research group.It is better for the follow-up stent implantation;Conclusion1.Individualized airway stent placement can effectively block the thoracic stomach-tracheal(bronchial)fistula;thoracic stomach-tracheal(bronchial)fistula complications can be effectively cured through the airway stent implatation,long-term survival and quality of life in patients were significantly improved.2.The placement of the nasal jejunum nutrition tube and gastric decompression tube could effectively improve the patients' preoperative constitution,and provide the opportunity for treatment.3.Tracheal/bronchial fistula occlusion stent embedded in the treatment of safe operation,the effect is obvious,patients benefit,valued a strong promotion in clinical. |
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