The Anatomic Research And Clinical Application Of Placing Esophageal Stent In Upper Esophageal Disease

Background and objective: The upper esophageal disease refers to the benign/malignant esophageal disease in the cervical segment and upper thoracic segment of esophagus, including gastroesophageal anastomosis fistula or carcinous stricture, esophageal carcinous stenosis with tracheal fistula, mediastinoesophageal fistula,esophageal carcinous stricture, esophageal radioactive stricture, corrosive esophagitis,etc. In these diseases, esophagus is so severely constricted that the patient can't take food or choked after meal that patient does not dare to eat food. Because the barrier of taking food, the patient is dying. There is a bad result in the internal medicine or non-efficient method in surgery.It is simple and safe, non-invasive method to treat esophageal disease and eliminate dysphagia after implanting stent successfully, which results in an extensive application. But stent is not popularly used in upper esophageal disease because of the enormous deviation in knowing the esophageal entrance and cervical anatomic structure. Cervical vertebra is mostly used as bony marker to locate the upper edge of stent in upper esophageal disease, some scholars thought the highest edge of stent can't surpass C7 or T1. The esophageal entrance changes greater with the movement of the head than that of the vertebra. Moreover, the position of the esophageal entrance can't be demonstrated accurately on X-ray according to the anatomic marker(vertebra).In order to study the adjacent structure and influence of esophageal entrance,make use of normal upper segment of esophagus, place stent accurately and reasonably, reduce the complication such as stent shifting and expand the indication of placing stent, the purpose of research is to study the anatomic relation of piriform recess and esophageal entrance, explore a practically feasible locating way of esopheal entrance, direct implanting esophageal stent in upper esophageal disease accurately and reasonably.Material and method:(1)On the basis of random trial and voluntary principle, 257 healthy people were registered about the name, age, height, weight, etc. The barium meal was given and radiography of the pharynx and esophagus was taken. 180 patients' pharynx and esophageal radiography were taken in 11X 14inch films and a patient'extension, normal, flexion, prone extension position were taken in a film separately. The flat head position was shot in 77 patients. The maginificant rate of X-ray was adjusted in 10 cases with random trial. The vertebra was divided into three equal parts and the intervertibral disc was regarded as one part according to X-ray films. The position of vertebra corresponding to the extreme of the piriform recess was recorded separately. Taking the inferior level of C5 as a baseline, calliper and vernier caliper were used to measure the distance between the inferior piriform recess and the baseline. On the film of normal position, caliper and vernier caliper were used to measure the distance between the midpoint of the superior edge of C5 and the midpoint of the inferior edge of C6.(2)The anatomical relationships between inferior piriform recess and inferior cricoid cartilage, inferior piriform recess and inferior level of C5, inferior cricoid cartilage and inferior level of C5 were measured with caliper and vernier caliper with l/50mm.(3)26 patients with upper esophageal disease(male 20 cases, female 6 cases), average age 52.0 + 22.3 years old. In this group,there were 10 patients with gastroesophageal anastomosis fistula, 4 with gastroesophageal carcinous stricture, 2 with gastroesophageal carcinous stricture and tracheal fistula, 6 with upper esophageal carcinous stenosis with tracheal fistula and 4 with corrosive esophagitise. The esophageal stent was selected on the bases of the character, length, position ofesophageal disease. The patient lay on the operating table, lifting his head and facing forward as much as possible, Stent was placed under the fluoroscopic guidance. Re-radiography was taken after the placement of esophageal stent to know t...