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Эндоскопическое стентирование при злокачественных пищеводно-респираторных фистулах
Иванов А.И., Попов В.А., Бурмистров М.В. Эндоскопическое стентирование при злокачественных пищеводно-респираторных фистулах. Consilium Medicum. 2020; 22 (8): 32–35. DOI: 10.26442/20751753.2020.8.200283
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Ivanov A.I., Popov V.A., Burmistrov M.V. Endoscopic stenting for malignant esophago-respiratory fistulas. Consilium Medicum. 2020; 22 (8): 32–35.
DOI: 10.26442/20751753.2020.8.200283
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Аннотация
Более 70% всех случаев злокачественных свищей возникает у пациентов с распространенным раком пищевода. Частота их возникновения при неоперабельном раке пищевода увеличилась за последние 30 лет более чем на 10%, что обусловлено более широким применением современных паллиативных методов лечения. Стентирование пищевода у данной тяжелой группы больных является эффективным методом выбора с низкими показателями осложнений. В статье приведены результаты имплантации пищеводных стентов под видеоэндоскопическим контролем при злокачественных эзофагореспираторных свищах в условиях Республиканского клинического онкологического диспансера за период с 2011 по 2019 г. Стенты имплантированы 22 больным с разной злокачественной патологией. В статье проведен анализ сроков и факторов возникновения свищей, а также возникших осложнений, способов их профилактики и методов эндоскопической коррекции. Выполнен анализ продолжительности жизни в зависимости от возраста больных, основного заболевания, локализации и сообщения злокачественных свищей. Успешная имплантация достигнута в 19 случаях. Осложнения отмечены в 5 случаях. Средняя продолжительность жизни больных составила 52 дня. Стентирование пищевода при злокачественных фистулах пищевода и пищеводных анастомозах является эффективным методом выбора паллиативного лечения.
Ключевые слова: рак пищевода, эзофагореспираторный свищ, стентирование.
Ключевые слова: рак пищевода, эзофагореспираторный свищ, стентирование.
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More than 70% of all cases of malignant fistula occur in patients with advanced cancer of the esophagus. The frequency of their occurrence with inoperable cancer of the esophagus has increased over the past 30 years by more than 10%, due to the wider use of modern palliative treatment methods. Esophageal stenting in this severe group of patients is an effective method of choice with low rates of complications. The article presents the results of the implantation of esophageal stents under video endoscopic control in case of malignant esophago-respiratory fistula in the conditions of the Republican Clinical Oncology Dispensary for the period from 2011 to 2019. Stents were implanted in 22 patients with various malignant pathologies. The article analyzes the timing and factors of the occurrence of fistulas, as well as the complications that have arisen, methods of their prevention and methods of endoscopic correction. The analysis of life expectancy is performed depending on the age of the patients, underlying disease, localization and reporting of malignant fistulas. Successful implantation was achieved in 19 cases. Complications were noted in 5 cases. The average life expectancy of patients was 52 days. Esophageal stenting for malignant esophageal fistulas and esophageal anastomoses is an effective method of choosing palliative treatment.
Key words: esophageal carcinoma, respiratory-digestive fistula, stenting.
Полный текст
Список литературы
1. Marczyński W, Pająk M, Komandowska T et al. Self-expandable metallic stents in oesophago-respiratory fistul as treatment in neoplasms – case reports and literature review. Pneumonol Alergol Pol 2015; 83: 303–6. DOI: 10.5603/PiAP.2015.0050
2. Martini N, Goodner JT, D'Angio GJ et al. Tracheoesophageal fistula due to cancer. J Thorac Cardiovasc Surg 1970; 59: 319–24. DOI: 10.1016/S0022-5223(19)42464-1
3. Balazs A, Galambos Z, Kupcsulik PK. Characteristics of esophagorespiratory fistulas resulting from esophageal cancers: A single-center study on 243 cases in a 20-year period. World J Surg 2009; 33: 994–1001. DOI: 10.1007/s00268-009-9988-3
4. Angorn IB. Intubation in the treatment of carcinoma of the esophagus. World J Surg 1981; 5: 535–41. DOI: 10.1007/BF01655006
5. Duranceau A, Jamieson GG. Malignant tracheoesophageal fistula. Ann ThoracSurg 1984; 37: 346–54. DOI: 10.1016/s0003-4975(10)60745-x
6. Hürtgen M, Herber SC. Treatment of malignant tracheoesophageal fistula. Thorac Surg Clin 2014; 24: 117–27. DOI: 10.1016/j.thorsurg.2013.09.006
7. Shin JH, Song HY, Ko G et al. Esophagorespiratory fistula: Long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology 2004; 232: 252–9. DOI: 10.1148/radiol.2321030733
8. Murthy S, Gonzalez-Stawinski GV, Rozas MS et al. Palliation of malignant aerodigestive fistulae with self-expanding metallic stents. Dis Esophagus 2007; 20: 386–9. DOI: 10.1111/j.1442-2050.2007.00689.x
9. Wang H, Ke M, Li W et al. Chinese expert consensus on diagnosis and management of acquired respiratory-digestive tract fistulas. Thorac Cancer 2018; 9 (11): 1544–55. DOI: 10.1111/1759-7714.12856
10. Włodarczyk JR, Kużdżał J. Safety and efficacy of airway stenting in patients with malignant oesophago-airway fistula. J Thorac Dis 2018; 10 (5): 2731–9. DOI: 10.21037/jtd.2018.05.19
11. Burt M, Diehl W, Martini N et al. Malignant esophagorespiratory fistula: management options and survival. Ann Thorac Surg 1991; 52: 1222–8. DOI: 10.1016/0003-4975(91)90005-b
12. Davydov M, Stilidi I, Bokhyan V et al. Surgical treatment of esophageal carcinoma complicated by fistulas. Eur J Cardiothorac Surg 2001; 20: 405–8. DOI: 10.1016/S1010-7940(01)00796-5
13. Colt HG, Meric B, Dumon JF. Double stents for carcinoma of the esophagus invading the tracheo-bronchial tree. Gastrointest Endosc 1992; 38: 485–9. DOI: 10.1016/s0016-5107(92)70482-9
14. Shin JH, Kim JH, Song HY. Interventional management of esophagorespiratory fistula. Korean J Radiol 2010; 11: 133–40. DOI: 10.3348/kjr.2010.11.2.133
15. Abadal JM, Echenagusia A, Simo G et al. Treatment of malignant esophagorespiratory fistulas with covered stents. Abdom Imaging 2001; 26: 565–9. DOI: 10.1007/s002610000193
16. Saxon RR, Barton RE, Katon RM et al .Treatment of malignant esophageal obstructions with covered metallic Z stents: Long-term results in 52 patients. J Vasc Interv Radiol 1995; 6: 747–54. DOI: 10.1016/s1051-0443(95)71180-0
17. Kishi K, Nakao T, Goto H et al. A fast placement technique for covered tracheobronchial stents in patients with complicated esophagorespiratory fistulas. Cardiovasc Intervent Radiol 2005; 28: 485–9. DOI: 10.1007/s00270-003-0203-x
18. Balazs A, Kupcsulik PK, Galambos Z. Esophagorespiratoryfistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period. Eur J Cardiothorac Surg 2008; 34: 1103–7. DOI: 10.1016/j.ejcts.2008.06.025
19. Nam DH, Shin JH, Song HY et al. Malignant esophageal-tracheobronchial strictures: Parallel placement of covered retrievable expandable nitinol stents. Acta Radiol 2006; 47: 3–9. DOI: 10.1080/02841850500334989
20. Binkert CA, Petersen BD. Two fatal complications after parallel tracheal-esophageal stenting. Cardiovasc Intervent Radiol 2002; 25: 144–7. DOI: 10.1007/s00270-001-0088-5
2. Martini N, Goodner JT, D'Angio GJ et al. Tracheoesophageal fistula due to cancer. J Thorac Cardiovasc Surg 1970; 59: 319–24. DOI: 10.1016/S0022-5223(19)42464-1
3. Balazs A, Galambos Z, Kupcsulik PK. Characteristics of esophagorespiratory fistulas resulting from esophageal cancers: A single-center study on 243 cases in a 20-year period. World J Surg 2009; 33: 994–1001. DOI: 10.1007/s00268-009-9988-3
4. Angorn IB. Intubation in the treatment of carcinoma of the esophagus. World J Surg 1981; 5: 535–41. DOI: 10.1007/BF01655006
5. Duranceau A, Jamieson GG. Malignant tracheoesophageal fistula. Ann ThoracSurg 1984; 37: 346–54. DOI: 10.1016/s0003-4975(10)60745-x
6. Hürtgen M, Herber SC. Treatment of malignant tracheoesophageal fistula. Thorac Surg Clin 2014; 24: 117–27. DOI: 10.1016/j.thorsurg.2013.09.006
7. Shin JH, Song HY, Ko G et al. Esophagorespiratory fistula: Long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology 2004; 232: 252–9. DOI: 10.1148/radiol.2321030733
8. Murthy S, Gonzalez-Stawinski GV, Rozas MS et al. Palliation of malignant aerodigestive fistulae with self-expanding metallic stents. Dis Esophagus 2007; 20: 386–9. DOI: 10.1111/j.1442-2050.2007.00689.x
9. Wang H, Ke M, Li W et al. Chinese expert consensus on diagnosis and management of acquired respiratory-digestive tract fistulas. Thorac Cancer 2018; 9 (11): 1544–55. DOI: 10.1111/1759-7714.12856
10. Włodarczyk JR, Kużdżał J. Safety and efficacy of airway stenting in patients with malignant oesophago-airway fistula. J Thorac Dis 2018; 10 (5): 2731–9. DOI: 10.21037/jtd.2018.05.19
11. Burt M, Diehl W, Martini N et al. Malignant esophagorespiratory fistula: management options and survival. Ann Thorac Surg 1991; 52: 1222–8. DOI: 10.1016/0003-4975(91)90005-b
12. Davydov M, Stilidi I, Bokhyan V et al. Surgical treatment of esophageal carcinoma complicated by fistulas. Eur J Cardiothorac Surg 2001; 20: 405–8. DOI: 10.1016/S1010-7940(01)00796-5
13. Colt HG, Meric B, Dumon JF. Double stents for carcinoma of the esophagus invading the tracheo-bronchial tree. Gastrointest Endosc 1992; 38: 485–9. DOI: 10.1016/s0016-5107(92)70482-9
14. Shin JH, Kim JH, Song HY. Interventional management of esophagorespiratory fistula. Korean J Radiol 2010; 11: 133–40. DOI: 10.3348/kjr.2010.11.2.133
15. Abadal JM, Echenagusia A, Simo G et al. Treatment of malignant esophagorespiratory fistulas with covered stents. Abdom Imaging 2001; 26: 565–9. DOI: 10.1007/s002610000193
16. Saxon RR, Barton RE, Katon RM et al .Treatment of malignant esophageal obstructions with covered metallic Z stents: Long-term results in 52 patients. J Vasc Interv Radiol 1995; 6: 747–54. DOI: 10.1016/s1051-0443(95)71180-0
17. Kishi K, Nakao T, Goto H et al. A fast placement technique for covered tracheobronchial stents in patients with complicated esophagorespiratory fistulas. Cardiovasc Intervent Radiol 2005; 28: 485–9. DOI: 10.1007/s00270-003-0203-x
18. Balazs A, Kupcsulik PK, Galambos Z. Esophagorespiratoryfistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period. Eur J Cardiothorac Surg 2008; 34: 1103–7. DOI: 10.1016/j.ejcts.2008.06.025
19. Nam DH, Shin JH, Song HY et al. Malignant esophageal-tracheobronchial strictures: Parallel placement of covered retrievable expandable nitinol stents. Acta Radiol 2006; 47: 3–9. DOI: 10.1080/02841850500334989
20. Binkert CA, Petersen BD. Two fatal complications after parallel tracheal-esophageal stenting. Cardiovasc Intervent Radiol 2002; 25: 144–7. DOI: 10.1007/s00270-001-0088-5
________________________________________________
1. Marczyński W, Pająk M, Komandowska T et al. Self-expandable metallic stents in oesophago-respiratory fistul as treatment in neoplasms – case reports and literature review. Pneumonol Alergol Pol 2015; 83: 303–6. DOI: 10.5603/PiAP.2015.0050
2. Martini N, Goodner JT, D'Angio GJ et al. Tracheoesophageal fistula due to cancer. J Thorac Cardiovasc Surg 1970; 59: 319–24. DOI: 10.1016/S0022-5223(19)42464-1
3. Balazs A, Galambos Z, Kupcsulik PK. Characteristics of esophagorespiratory fistulas resulting from esophageal cancers: A single-center study on 243 cases in a 20-year period. World J Surg 2009; 33: 994–1001. DOI: 10.1007/s00268-009-9988-3
4. Angorn IB. Intubation in the treatment of carcinoma of the esophagus. World J Surg 1981; 5: 535–41. DOI: 10.1007/BF01655006
5. Duranceau A, Jamieson GG. Malignant tracheoesophageal fistula. Ann ThoracSurg 1984; 37: 346–54. DOI: 10.1016/s0003-4975(10)60745-x
6. Hürtgen M, Herber SC. Treatment of malignant tracheoesophageal fistula. Thorac Surg Clin 2014; 24: 117–27. DOI: 10.1016/j.thorsurg.2013.09.006
7. Shin JH, Song HY, Ko G et al. Esophagorespiratory fistula: Long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology 2004; 232: 252–9. DOI: 10.1148/radiol.2321030733
8. Murthy S, Gonzalez-Stawinski GV, Rozas MS et al. Palliation of malignant aerodigestive fistulae with self-expanding metallic stents. Dis Esophagus 2007; 20: 386–9. DOI: 10.1111/j.1442-2050.2007.00689.x
9. Wang H, Ke M, Li W et al. Chinese expert consensus on diagnosis and management of acquired respiratory-digestive tract fistulas. Thorac Cancer 2018; 9 (11): 1544–55. DOI: 10.1111/1759-7714.12856
10. Włodarczyk JR, Kużdżał J. Safety and efficacy of airway stenting in patients with malignant oesophago-airway fistula. J Thorac Dis 2018; 10 (5): 2731–9. DOI: 10.21037/jtd.2018.05.19
11. Burt M, Diehl W, Martini N et al. Malignant esophagorespiratory fistula: management options and survival. Ann Thorac Surg 1991; 52: 1222–8. DOI: 10.1016/0003-4975(91)90005-b
12. Davydov M, Stilidi I, Bokhyan V et al. Surgical treatment of esophageal carcinoma complicated by fistulas. Eur J Cardiothorac Surg 2001; 20: 405–8. DOI: 10.1016/S1010-7940(01)00796-5
13. Colt HG, Meric B, Dumon JF. Double stents for carcinoma of the esophagus invading the tracheo-bronchial tree. Gastrointest Endosc 1992; 38: 485–9. DOI: 10.1016/s0016-5107(92)70482-9
14. Shin JH, Kim JH, Song HY. Interventional management of esophagorespiratory fistula. Korean J Radiol 2010; 11: 133–40. DOI: 10.3348/kjr.2010.11.2.133
15. Abadal JM, Echenagusia A, Simo G et al. Treatment of malignant esophagorespiratory fistulas with covered stents. Abdom Imaging 2001; 26: 565–9. DOI: 10.1007/s002610000193
16. Saxon RR, Barton RE, Katon RM et al .Treatment of malignant esophageal obstructions with covered metallic Z stents: Long-term results in 52 patients. J Vasc Interv Radiol 1995; 6: 747–54. DOI: 10.1016/s1051-0443(95)71180-0
17. Kishi K, Nakao T, Goto H et al. A fast placement technique for covered tracheobronchial stents in patients with complicated esophagorespiratory fistulas. Cardiovasc Intervent Radiol 2005; 28: 485–9. DOI: 10.1007/s00270-003-0203-x
18. Balazs A, Kupcsulik PK, Galambos Z. Esophagorespiratoryfistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period. Eur J Cardiothorac Surg 2008; 34: 1103–7. DOI: 10.1016/j.ejcts.2008.06.025
19. Nam DH, Shin JH, Song HY et al. Malignant esophageal-tracheobronchial strictures: Parallel placement of covered retrievable expandable nitinol stents. Acta Radiol 2006; 47: 3–9. DOI: 10.1080/02841850500334989
20. Binkert CA, Petersen BD. Two fatal complications after parallel tracheal-esophageal stenting. Cardiovasc Intervent Radiol 2002; 25: 144–7. DOI: 10.1007/s00270-001-0088-5
Авторы
А.И. Иванов*1,2, В.А. Попов1,3, М.В. Бурмистров1,3
1 Казанская государственная медицинская академия – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Казань, Россия;
2 ГАУЗ «Республиканский клинический онкологический диспансер» Минздрава Республики Татарстан, Казань, Россия;
3 ГАУЗ «Республиканская клиническая больница» Минздрава Республики Татарстан, Казань, Россия
*a.i.ivanov@inbox.ru
1 Казанская государственная медицинская академия – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Казань, Россия;
2 ГАУЗ «Республиканский клинический онкологический диспансер» Минздрава Республики Татарстан, Казань, Россия;
3 ГАУЗ «Республиканская клиническая больница» Минздрава Республики Татарстан, Казань, Россия
*a.i.ivanov@inbox.ru
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Aleksej I. Ivanov*1,2,Vladimir A. Popov1,3, Mihail V. Burmistrov1,3
1 Kazan State Medical Academy – branch of the Russian Medical Academy of Continuous Professional Education, Kazan, Russia;
2 Republican Oncology Clinical Dispensery, Kazan, Russia;
3 Republican Clinical Hospital, Kazan, Russia
*a.i.ivanov@inbox.ru
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