Analysis Of Therapeutic Effect Of Metal Coated Stent In The Treatment Of Malignant Respiratory-digestive Fistulas

Objective:The purpose of this study was to investigate the success rate of metallic stent implantation for closure of malignant respiratory-digestive fistulas and to evaluate the short-term efficacy and safety of the treatment in Hunan Provincial People's Hospital.Methods:The clinical data of 21 patients with malignant respiratory-digestive fistulas treated in our hospital from May 2011 to February 2019 and the results of metal coated stent implantation were retrospectively analyzed.The results included age,sex,day cough symptom score,KPS score,blood oxygen saturation value,fistula location,fistula size and so on.These 21 patients who were not suitable for surgical operation and esophageal stent implantation,and who were implanted in the airway with Ultraflex stents or domestic metal stent(straight tube stent and Y-shaped stent produced by Nanjing Minimally Invasive Company)toocclude the fistula.The stents type,number and location of stents,closure of fistula after stents implantation,granulation tissue,airway secretion,stent displacement and fracture of the stent were recorded.The effectiveness and safety of metal-covered stent implantation in the treatment of malignant airway and digestive tract fistula were estimated.Results:During the study period,21 cases of malignant respiratory-digestive fistula were included,including 19 males and 2 females,aged 37-72 years,with an average age of 56.8±4.8years,including 7 cases of tracheoesophageal fistula,1 case of tracheothoracic-gastric fistula,1 case of left main bronchus-thoracic-gastric fistula,4 cases of left main bronchus,5 cases of right main bronchus,2 cases of left and right main bronchus fistula,and 1 case of tracheot.A total of 24 metal-coated stents were placed(10 for Y-shaped coated stents,4 for Ultraflex stents,and 10 for Nanjing minimally invasive straight stents);Nineteen patients successfully implanted 21 stents at one time,2 stents failed and 2 stents failed to occlude fistula.According to the symptoms of cough and the coverage of the fistula under bronchoscope by metal covered stent,17cases(89.4%)were completely relieved,1 cases(5.3%)were partially relieved,1 cases(5.3%)were ineffective,and the total effective rate was94.7%.There were 3 cases of granulation tissue hyperplasia,2 cases ofsecretion retention and 1 case of stent displacement.Before and after stent implantation,the scores of cough symptoms(preoperative 2.38 +0.67,postoperative 1.10 + 0.63),KPS scores(preoperative 48.57 + 23.93,postoperative 69.52 + 21.32),oxygen saturation(preoperative 91.57 +2.86,postoperative 96.52 + 1.63)were significantly improved,T values were 10.510,-9.080,-10.799,respectively.The P values were < 0.01.No fatal complications such as massive hemorrhage,hemoptysis and airway rupture occurred in all patients.Conclusion:The metallic stent placement for malignant respiratory-digestive fistulas is effective and safe,which is worthy of clinical promotion.