摘要目的 探讨食管覆膜内支架置入治疗食管胃吻合口颈部瘘的安全性及有效性.方法 回顾性分析2015年7月至2018年6月郑州大学附属肿瘤医院,采取食管覆膜内支架置入治疗食管胃吻合口颈部瘘患者的临床及影像资料.本组21例,男15例、女6例,均为食管癌根治性切除术后食管胃吻合口瘘患者,所有瘘口均位于食管颈段,于术后2～13 d诊断.根据食管造影测量食管残留长度、瘘口位置和大小,个体化选择食管内支架.观察支架置入术后随访中的并发症.采用胸部CT检查脓腔愈合情况,食管造影了解瘘口是否愈合.所有患者采用复查随访和电话随访,随访6个月以上.结果 21例患者中,19例(90.5%)一次性成功置入食管覆膜内支架;2例(9.5%)释放支架位置偏下,通过回收线上拉调整内支架位置成功放置.食管内支架置入10～60 d,平均(31±19)d,瘘口愈合后顺利取出内支架,支架取出用时6～23 min.随访中患者瘘口均未复发.4例出现吻合口瘢痕性狭窄,采取球囊扩张后进食顺利.结论 食管覆膜内支架置入治疗食管胃吻合口颈部瘘安全、有效.

abstractsObjective To investigate the effectiveness and safety of esophageal covered stent for the treatment of esophagogastric cervical anastomotic fistula. Methods Retrospective analysis of clinical and imaging data of patients with esophageal and gastric anastomotic neck fistula treated by esophageal membrane stent implantation in the Affiliated Tumor Hospital of Zhengzhou University from July 2015 to June 2018. Twenty‐one cases, 15 males and 6 females were enrolled. All patients showed fistula after esophagogastrostomy for esophageal carcinoma. All the fistulas were located in the cervical segment of esophagus and were diagnosed as anastomotic fistula 2 to 13 days after surgery. The length of esophagus residue, the position and size of the fistula were measured by esophagography. We retrospectively analyzed the data of patients with cervical anastomotic fistula treated with esophageal covered stent. Patients were followed up for more than 6 months by review and telephone follow‐up. Results In the 21 patients, 19 (90.5%) were successfully implanted stents at one time, and 2 (9.5%) were placed at a lower position. The esophageal stent was implanted for 10 to 60 days (31±19) days, and the stent was successfully removed after the fistula healed, with a procedure time of 6 to 23 minutes. No recurrence of fistula was found during follow‐up. Four patients had anastomotic scar stenosis, and eating smoothly after balloon dilatation. Conclusion Esophageal covered stent implantation is a safe and effective technique for gastroesophageal cervical anastomotic fistula.