| Background and objectiveEsophageal cancer is one of the most common gastrointestinal tumors in China. Surgical resection is the most important means of treatment of esophageal cancer at present. Stomach esophagus anastomosis is one of the serious complications after esophagectomy, chest anastomotic fistula rate3%to5%, mortality rate as high as50%, cervical anastomotic fistula has a higher rate up to5-14%. Most scholars advocate esophageal sub-total, stomach esophagus anastomosis of the neck, on one hand, it can get the greatest degree of resection of esophageal primary lesions, reducing the incidence of residual carcinoma of the cutting edge; on the other hand, even in the event of esophagogastric anastomotic leakage, generally there will be no danger to the patients, reducing anastomotic fistula-related mortality rate.Patients with smaller cervical anastomotic fistula can be healed in the short term after conservative treatment under most conditions. For patients with big cervical anastomotic fistula, if they simply take a conservative treatment, the fistula heals slowly and anastomotic benign strictures can merge easily. As the residual normal esophagus of esophagogastric cervical anastomosis is very short, conventional esophageal stent is not easy be fixed, prone to shift. There are currently no esophageal stent dedicated to the treatment of stomach esophagus cervical anastomosis. According to the anatomical characteristics and lesion characteristics of the stomach esophagus cervical anastomosis after esophageal cancer operation, this study designs specific blocking stent for neck anastomotic fistula, evaluating the safety and efficiency of the personalized stent.Materials and methodsObservative group come from radiation intervention department in the first affiliated hospital of Zhengzhou university, the36patients were given cervical anastomosis after esophageal cancer operation from October,2009to December,2011, male28,female8, aged52-79(median age64.00±7.45), using personalized blocking stent for neck anastomotic fistula. Control group analysis conditions of31patients, who come from radiation intervention department in the first affiliated hospital of Zhengzhou university, cerebral surgery department of the first affiliated hospital of Zhengzhou university, or cerebral surgery department of the second affiliated hospital of Zhengzhou university, they got neck anastomotic fistula after esophageal cancer operation, male23, female8, aged47-83(median age63.81±9.37), simply conservative treatment. Observations of the two groups involved complications after using personalized stent, fistula healing time, anastomotic benign stricture mergeing condition, survival time and patients’statement compared with pure conservative treatment group.Results1. Of the36cases in the stents treatment group,32felt pain,36had pharyngeal foreign body sensation,1hoarseness,6got gastroesophageal reflux,1felt hemoptysis,2bled from esophageal,13had stent migration.2. The fistula healing time of the group of stents treatment is9～32days (median time,20.25±5.87);29cases got their healing of wounds in the conservative treatment group, the fistula healing time is36-95days (median time,67.00±15.82),2cases failed to healing before follow-up deadline (P<0.05)3.6cases were found anastomosis stricture in the stents treatment group, compared to21cases in the conservative treatment group (P<0.05)4. The median survival time was19.50months in the stents treatment group, compared to21.57months in the conservative treatment group (P>0.05)Conclusions1. The use of individual cervical anastomotic leaks self-expanded covered stent in the esophagogastrostomy for esophageal cancer, which is with good security, can decrease the incidence rate of the complications.2. Compared to the conservative therapy, the leaks cost less time to heal up with the use of stent which aslo can decrease the incidence rate of benign anastomotic stricture. |
