【作者】 李超杰；

【导师】 滕皋军；

【作者基本信息】 东南大学 ， 影像医学与核医学（专业学位）， 2017， 硕士

【摘要】 目的:评估支架置入治疗恶性食管气管瘘的疗效,并探讨影响患者术后生存的相关危险因素。方法:回顾性分析自2015年1月至2016年12月在东南大学附属中大医院介入与血管外科行支架置入的恶性食管气管痿患者。收集患者一般人口学特征、临床及影像数据、手术及术后相关数据结果,评估技术成功率、瘘口封闭率、KPS评分、感染控制、并发症、生存等结果。通过对潜在危险因素单因素和Cox回归分析,筛选可能影响患者术后生存的危险因素。结果:共纳入46例患者,30例置入食道支架,6例置入气道支架,10例置入食道-气道双支架。共置入支架56枚,食道支架40枚,气道支架16枚,技术成功率100%。45例患者瘘口封闭成功,瘘口封闭率为97.8%。所有患者术后1周(54.57±8.09)、1月(68.04±10.25)、2 月(54.56±14.49)、3 月(52.57±16.81)KPS评分与术前KPS评分(39.78±7.15)比较,差异有统计学意义(P<0.05)。24例术前存在肺部感染的患者中,19例术后感染得到控制,感染控制率为79.2%(19/24)。此外,7例患者术后出现新发肺部感染,经治疗后6例患者感染得到控制。术后两周至患者死亡,26例患者术后两次及两次以上随访出现肺部感染状态,长期肺部感染控制不佳。术后早期(<48h)并发症13例,包括:胸骨后疼痛9例(19.5%),呼吸困难2例(4.4%),消化道出血1例(2.2%);晚期(≥48h)并发症24例,包括:瘘口开放9例(19.5%),支架堵塞8例(17.3%),消化道出血4例(8.7%),胸骨后疼痛3例(6.5%)。患者术后平均生存时间为105±24天。单因素分析结果显示:既往接受放射治疗(P=0.003),瘘口再次开放(P=0.015),术后长期感染控制情况(P=0.008)术后生存期有差异,差异有统计学意义。将可能的危险因素进行Cox多元回归分析显示:既往接受放射治疗(B=-0.800,?=0.021)、术后长期感染控制情况(B=0.599,P=0.039)对患者术后生存有影响。结论:支架置入是治疗恶性食管气管瘘的有效姑息治疗方法,术后内能明显缓解患者症状,提高患者生活质量。对于既往接受过放射治疗的食管气管瘘患者而言,支架置入疗效欠佳;支架置入术后需要严格控制感染。更多还原

【Abstract】 Purpose We aim to explore the efficacy of stent implantation in the treatment of malignant tracheoesophageal fistula and evaluate the risk factors of survival after stent implantation.Materials and Methods Between January 2015 and December 2016,patients who un-derwent stent implantation for malignant tracheoesophageal fistula in Zhongda Hospital,Southeast University were retrospectively enrolled.The main outcomes were evaluated in term of technique success,fistula closure,KPS scores,infection control,complication and overall survival.Risk factors selected by univariate analysis for survival were identified by Cox’s proportional hazards regression model.Results 46 patients were included in this study,including 30 underwent esophageal stent implantation,6 underwent airway stent implantation and 10 underwent esophageal-airway double stents implantation.56 stents including 40 esophageal stent and 16 airway stent were successfully implanted,the technique success rate was 100%.45 of 46 fistulas(97.8%)were successfully closed.Postoperative KPS scores had been improved at 1 week(54.57±8.09),1month(68.04± 10.25),2 month(54.56± 14.49)and 3 month(52.57± 16.81)with preopera-tive KPS scores(39.78 ±7.15)(P<0.05).24 patient had pneumonias before operation and 19(79.2%)pneumonias were controlled after stent implantation.7 new pneumonias occurred af-ter stent implantation and 6 were controlled within 2 weeks.26 patients had uncontrolled long-term infections.Early complication:pain(9/46,19.5%),dyspnea(4.4%,2/46),hemor-rhage(2.2%,1/46).Late complication:fistula reopening(9/46,19.5%),stent blockage(17.3%,8/46),hemorrhage(8.7%,4/46),pain(3/46,6.5%).The mean survival time was 105 ±24 days.Univariate analysis for potential risk factors showed that past radiation therapy(P=0.003),fis-tula reopening(P=0.015),long-term infection control(P=0.008)were associated with survival time after stent implantation.Cox’s proportional hazards regression model showed that past radiation therapy(B=-0.800,P=0.021),long-term infection control(B=0.599,P=0.039)were independent risk factors of survival time after stent implantation.Conclusion Stent implantation is an effective palliative treatment for malignant trache-oesophageal fistula,especially in relieving the symbols and improving the quality of life.To patients who had previous radiation therapy history,efficacy of stent implantation is not good enough.Infection should be controlled strictly after stent implantation.更多还原