摘要目的 探讨Y型一体化自膨式覆膜气道金属支架(Y型支架)在胸腔胃-气道瘘治疗中的安全性和疗效.方法 回顾性分析2003年4月到2014年10月郑州大学第一附属医院放射介入科收治的108例胸腔胃-气道瘘患者临床及影像学资料,其中男90例,女18例,年龄41 ～75(60±10)岁.根据瘘口的位置、大小及相关气道直径,个体化设计1～3枚Y型支架(其中跨越隆突区域放置的支架简称大Y支架,跨越叶支气管分叉处放置的简称小Y支架).在X线监视下行病变处气道内支架置入,其中单一大Y支架置入65例、单一小Y支架置入16例、大Y+小Y支架组合置入26例,大Y+双小Y支架组合置入1例.结果 所有患者Y型支架均一次置入成功,104例术后即刻气道和食管造影均未见对比剂进入对侧,瘘口封堵完全,4例置入单Y支架后瘘口封堵不严,后改为大Y+小Y支架置入并封堵完全;术后患者卧位刺激性呛咳症状消失,可正常进食水,生活质量明显提高.术后92例患者获得完整随访,其中59例患者于术后3.1 ～9.0个月死亡,死因包括晚期肿瘤消耗(38例)、恶病质进展(14例)、肺部感染(5例)以及大咯血(2例);4例患者单Y支架置入2 ～10个月后瘘口增大,再次给予1枚Y型支架组合置入并证实瘘口封堵完全;余33例患者存活,生活质量满意.结论 Y型一体化自膨式覆膜金属支架气道内置入能有效封堵胸腔胃-气道瘘,技术可行,近期疗效可靠,能显著提高患者生活质量.

abstractsObjective To investigate the clinical feasibility and efficacy of Y-shaped selfexpandable covered metal stents (Y-stents) in the management of thoracostomach-airway fistula.Methods Retrospective analysis was performed for 108 patients treated for thoracostomach-airway fistula with Y-shaped self-expandable coated metal stents between April 2003 and October 2014.Y-stents were designed based on the dimensions of trachea and bronchus and sites of the fistula and then were inserted under DSA monitoring.There were 65 cases with single big Y-stent placement,26 cases with single small Y-stent placement,23 cases with double Y-stents placement,and 1 case with 3 Y-stents placement.Results Stent implantation was successfully accomplished with single manipulation in all patients.Complete occlusion of the fistula was obtained in 104 patients after the primary manipulation,and 4 patients required a secondary manipulation where a double Y-stents was inserted because of failure of primary manipulate.Ninety-two patients completed the follow-up,while 16 were lost.Fifty-nine patients died while 33 were alive with marked improvement in their quality of life.Conclusion The placement of Y-stents can effectively occlude the thoracostomachairway fistula in patients who had had the esophageal tumors resected.The technique is not only feasible but reliable to improve the quality of life of the patients.