挽救生命的经声带支架置入术治疗高位近端气管食管瘘：一种保守的内镜方法。

文献信息

中文摘要

背景： 无法手术的恶性气管食管瘘的管理仍然具有挑战性，尤其是当瘘口位于声带正下方时。我们描述了一种定制的经声带可变口径硅酮支架，该支架由两种市售支架在术中组装而成，用于三名食管癌伴高位近端气管食管瘘的患者。方法：术前规划结合了内镜检查、对比增强CT和三维重建。所有操作均在深度镇静并保留自主呼吸下通过硬质支气管镜进行。结果：装置置入无技术并发症，实现了瘘口封堵，并允许在24小时内经口补水，随后逐步重新引入经口进食。随访时间分别为18、10和8个月。一名患者因晚期假体感染需要更换支架；未发生其他重大支架相关并发症。结论：对于复杂近端气道解剖结构且传统单口径或快速制造的患者特异性装置不合适的特定患者，该方法提供了一种即时可用且术中可调整的选择。

英文摘要

Management of non-operable malignant tracheoesophageal fistulas remains challenging, particularly when the communication is located immediately below the vocal cords. We describe a customized transcordal variable-caliber silicone stent assembled intraoperatively from two commercially available stents in three patients with esophageal cancer and high proximal tracheoesophageal fistulas. Preprocedural planning combined endoscopy, contrast-enhanced CT, and three-dimensional reconstructions. All procedures were performed by rigid bronchoscopy under deep sedation with spontaneous ventilation. The devices were deployed without technical complications, achieved fistula exclusion, and allowed oral hydration within 24 h followed by gradual reintroduction of oral feeding. Follow-up was 18, 10, and 8 months. One patient required stent replacement for late prosthetic infection; no other major stent-related complications occurred. This approach provides an immediately available and intraoperatively adjustable option for selected patients with complex proximal airway anatomy when conventional single-caliber or rapidly manufactured patient-specific devices are unsuitable.