| Background and objective:Thoracostomach-airway fistula(TSAF)mainly occurs in patients undergoing radical esophageal cancer surgery with reconstruction of the esophagus and digestive tract.Esophageal cancer is one of the most common gastrointestinal malignant tumor in the world.It ranks 7th and 6th in the tumor spectrum of new cases and deaths of cancer worldwide.The new cases and deaths of esophageal cancer are located at the 6th and 4th in domestic tumor spectrum,accounting for 43.0%and 37.0%of the world's new cases and deaths of esophageal cancer,respectively.At present,the treatment of advanced esophageal cancer shows the trend of surgical radical resection after tumor reduction,which increases the base of thoracostomach-airway fistula.Thoracostomach-bronchus fistula(TSBF)is common types of thoracostomach-airway fistula.The fistula is located at the main bronchus or lobular bronchus.It's complex and difficult to manage the fistula because the bifurcation or branches of bronchus.This study collected the data of patients with TSBF retrospectively,aiming to analyze the clinical efficacy and reasons for the failure of sealing for TSBF treated with individualized Y shaped self-expanding integrated memory alloy covered airway stent,and explore the risk factors that affect the survival of patients after the placement of airway stent to help make treatment strategy after stent implanting of TSBF patients.Materials and methods:A retrospective analysis of patients with TSBF received airway stent treatment in the Department of Interventional radiology at the First Affiliated Hospital of Zhengzhou University from January 1,2011 to June 1,2019.Collect patient's general data,clinical symptoms,imaging data,airway stent placement surgery and postoperative complications,survival and other relevant data,caculate technical success rate?immediate and long-term occlusion of fistula?infection controls and complications,and a multi-factorial logistics analysis of the reasons for the failure of long-term fistula occlusion,Cox multi-factor analysis of patients' survival data,screening out risk factors that may affect the long-term fistula closure and the survival of patients after stenting.Result:A total of 102 patients were diagnosed with TSBF after radical surgery for esophageal cancer,including 85 males and 17 females,with an average age of(60.28±6.29)years.50 patients were treated with a single Y shaped stent,and 52 patients were treated with two combined Y shaped covered stent.One of the patients failed to release the stent when the two combined Y shaped stent were placed,and the two cases were not completely sealed immediately after the single Y shaped stent was placed,which was rejected in the later analysis.The technology success rate was 99.02%(101/102),and the immediate fistula sealing rate was 98.02%(99/101).Two weeks after stenting,lung infections had significantly improved in 82(82.82%)patients,and fistula closure completely in 80(80.80%)patients.During follow-up,35 patients(35.36%)come out sputum retention,19 patients(19.19%)succeeded with stent-associated pneumonia,31 patients(31.31%)were found intrastent restenosis,1 patient(1.01%)had hemoptysis,and 23 patients(23.23)%)failed in long-term fistula closure.Univariate analysis of long-term fistula sealing failure after stenting showed that:the distance between the fistula edge and the bifurcation(P=0.014),infection controls after stenting(P=0.012),and stent selection(P=0.001)has a significant effect on the failure of long-term fistula sealing after stenting,and the difference is statistically significant;multivariate logistic regression analysis shows that the distance between the fistula edge and the bifurcation(P=0.006)and stent selection(P=0.001)had a significant effect on the failure of long-term fistula sealing after operation,and the difference was statistically significant.Univariate analysis of survival data of patients after stenting showed:age(P=0.03),fistula location(P<0.001),tumor recurrence(P=0.002),postoperative infection control status(P<0.001),postoperative sputum retention(P=0.024)were significant differences in the survival time of patients in each subgroup,and the differences were statistically significant.Cox-multiple regression analysis of possible risk factors showed that:the P value of subgroup with the age older than 60 years(P=0.029),postoperative infection controlled(P=0.026)was statistically different;after medical judgment,it was considered that age was a confused factor,the control of infection is a protective factor for the survival of patients after stent implantation;fistula sites such as:located in the right main bronchus(P<0.001)?right middle bronchus(P=0.010),complications with sputum retention after stenting(P=0.005),tumor recurrence(P<0.001)are the risk factors that affect the survival of patients after stent surgery.Conclusion:(1)The placement of individualized Y shaped airway stent is an effective method for the treatment of TSBF after esophageal cancer surgery,and it is safe and reliable technically.(2)The distance from the edge of the fistula to the bronchus bifurcation and the choice of stent are the risk factors affect the long-term sealing of fistula.For fistula with a distance less than 5mm,the placement of two Y-shaped combined stent may improve the long-term success rate of fistula closure.(3)The control of pulmonary infection after stent placement can benefit patients'survival.And TSBF patients with fistula located in the right main orright middle bronchus,tumor recurrence,and sputum retention after stenting have a shorter survival period,so infection control actively and sputum management timely are very important for patients' prognosis. |
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