VAC-Stent作为食管穿孔手术修复及自膨式金属支架治疗失败后的挽救治疗

文献信息

中文摘要

背景： 食管穿孔是一种危及生命的疾病，需要及时且个体化的处理。尽管手术修复仍是既定的治疗选择，但内镜治疗在部分患者中已日益发挥作用。方法：我们报告一例在Nissen胃底折叠术后发生食管穿孔的患者。最初进行了急诊手术修复，但随后观察到持续性渗漏。随后放置了自膨式金属支架（SEMS）；然而，尽管接受了该治疗，瘘管仍持续存在。由于手术和常规内镜方法均已失败，遂采用内镜真空治疗联合食管支架（VAC-Stent）作为挽救治疗。结果：VAC-Stent同时提供了腔外空腔的引流和食管缺损的覆盖。连续内镜评估和装置更换使空腔逐渐消退，穿孔完全闭合。患者恢复经口进食，无复发性渗漏、吞咽困难或食管狭窄。治疗一年多后，患者仍无症状，生活质量良好。结论：本病例凸显了VAC-Stent治疗作为微创挽救选择，在手术修复和SEMS治疗均失败后的持续性食管穿孔中的潜在作用。

英文摘要

Esophageal perforation is a life-threatening condition requiring prompt and individualized management. Although surgical repair remains an established treatment option, endoscopic therapies have increasingly gained a role in selected patients. We report the case of a patient who developed an esophageal perforation following Nissen fundoplication. Emergency surgical repair was initially performed, but persistent leakage was subsequently observed. A self-expandable metal stent (SEMS) was then placed; however, the fistula persisted despite this treatment. As both surgical and conventional endoscopic approaches had failed, endoscopic vacuum therapy combined with an esophageal stent (VAC-Stent) was used as salvage therapy. The VAC-Stent provided simultaneous drainage of the extraluminal cavity and coverage of the esophageal defect. Serial endoscopic assessment and device exchanges resulted in progressive cavity resolution and complete closure of the perforation. The patient resumed oral intake without recurrent leakage, dysphagia, or esophageal stenosis. More than one year after treatment, the patient remains asymptomatic with a good quality of life. This case highlights the potential role of VAC-Stent therapy as a minimally invasive salvage option for persistent esophageal perforation after failure of both surgical repair and SEMS treatment.