应用覆膜自膨式金属支架经气管镜治疗术后高位气管食管瘘：2例转归不同病例的比较报告
Tracheoscopic Management of Postoperative High Tracheoesophageal Fistula Using Covered Self-Expanding Metallic Stents: A Comparative Report of 2 Cases With Divergent Outcomes.
文献信息
| PMID | 42955890 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Xiaodong Pang |
| 作者单位 | Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. |
| 期刊 | The American journal of case reports |
| SCI 分区 | Q3 |
| IF | 0.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 食管癌切除术后发生气管食管瘘（TEF）是一种罕见但危及生命的并发症。高位术后TEF的治疗，尤其是声门下区域，由于解剖限制和支架移位风险而面临显著的技术挑战。本报告评估经气管镜置入覆膜自膨式金属支架（CSEMS）治疗高位术后TEF的疗效。
病例报告： 我们报告2例食管癌手术后并发高位TEF的病例。病例1：一名67岁男性，瘘口直径0.6 cm，位于声带远端4 cm处。成功置入一枚直筒型CSEMS。四个月后，在确认黏膜完全愈合和上皮化后，因观察到肉芽组织增生而取出支架。病例2：一名78岁男性糖尿病患者，表现为位于声带远端3 cm处的大瘘口（12×8 mm）。初始直筒型CSEMS因反复移位而失败。随后更换为定制的球端型CSEMS，并辅以生物胶和明胶海绵。由于支架顽固性移位和愈合不良，最终采用经皮外部固定来稳定支架。
结论： 经气管镜置入CSEMS是治疗高位术后TEF的一种可行管理策略。然而，如我们2例病例的相反病程所示，在具有挑战性的声门下区域取得成功结局高度依赖于个体化支架选择和辅助措施。这些经验强调了技术适应性的重要性，同时需要更大规模的研究来界定最佳管理算法。
英文摘要
BACKGROUND Tracheoesophageal fistula (TEF) following esophageal cancer resection is a rare but life-threatening complication. Management of high postoperative TEF, particularly in the subglottic region, presents significant technical challenges due to anatomical constraints and the risk of stent migration. This report evaluates the efficacy of tracheoscopic placement of covered self-expanding metallic stents (CSEMS) for treating high postoperative TEF. CASE REPORT We report 2 cases of high TEF complicating esophageal cancer surgery. Case 1: A 67-year-old man with a 0.6 cm diameter fistula located 4 cm distal to the vocal folds. A straight CSEMS was successfully deployed. Four months later, after confirmation of complete mucosal healing and epithelialization, the stent was removed following the observation of granulation tissue hyperplasia. Case 2: A 78-year-old man with diabetes presented with a large (12×8 mm) fistula situated 3 cm distal to the vocal folds. An initial straight CSEMS failed due to repeated displacement. It was replaced with a customized ball-ended CSEMS and supplemented with biogel and -gelatin sponges. Due to refractory displacement and impaired healing, external percutaneous fixation was ultimately used to stabilize the stent. CONCLUSIONS Tracheoscopic CSEMS placement represents a viable management strategy for high postoperative TEF. However, successful outcomes in the challenging subglottic region are highly dependent on individualized stent selection and adjunctive measures, as illustrated by the contrasting courses of our 2 cases. These experiences underscore the importance of technical adaptability, while larger studies are needed to define optimal management algorithms.