CAJ | 학술논문

【目的】探讨食管支架相关并发症的外科治疗方法。【方法】回顾分析22例食管支架相关并发症患者的临床资料并复习有关文献。全组病人均手术治疗，根据原发疾病及并发症，选择不同手术方式：支架取出、食管瘘修补6例（4例脓胸二期行部分胸廓成形术），胸段食管癌切除、颈段食管外置5例（2例行二期胃代食管吻合术），胸段食管切除、胃代食管吻合5例，食管旷置、胸骨后结肠转流术5例，支架取出、食管气管瘘旷置1例。【结果】围手术期无死亡病例。1例行结肠转流术患者术后吻合口瘘，保守治疗治愈，无其他并发症发生。5例食管癌患者，3例分别于术后第6、7、9个月死亡，1例二期胃代食管吻合患者术后存活2年，因其他疾病死亡，另1例二期胃代食管吻合患者术后已随访半年，生活质量较前改善。除食管气管瘘旷置患者外，术后四个月内均恢复经口摄食。其他患者随访4～141个月，行瘘修补的患者无瘘再通发生，生活质量明显改善。【结论】外科手术是治疗食管支架相关并发症的有效手段。细致的术前评估及个体化手术方案是治疗成功的关键。
【목적】탐토식관지가상관병발증적외과치료방법。【방법】회고분석22례식관지가상관병발증환자적림상자료병복습유관문헌。전조병인균수술치료，근거원발질병급병발증，선택불동수술방식：지가취출、식관루수보6례（4례농흉이기행부분흉곽성형술），흉단식관암절제、경단식관외치5례（2례행이기위대식관문합술），흉단식관절제、위대식관문합5례，식관광치、흉골후결장전류술5례，지가취출、식관기관루광치1례。【결과】위수술기무사망병례。1례행결장전류술환자술후문합구루，보수치료치유，무기타병발증발생。5례식관암환자，3례분별우술후제6、7、9개월사망，1례이기위대식관문합환자술후존활2년，인기타질병사망，령1례이기위대식관문합환자술후이수방반년，생활질량교전개선。제식관기관루광치환자외，술후사개월내균회복경구섭식。기타환자수방4～141개월，행루수보적환자무루재통발생，생활질량명현개선。【결론】외과수술시치료식관지가상관병발증적유효수단。세치적술전평고급개체화수술방안시치료성공적관건。
[Objective] To explore the surgical treatment of complications after esophageal stenting .[Meth‐ods] The clinical data of 22 cases with complications after esophageal stenting were retrospectively examined with a review of related literature .All patients were operated .The underlying esophageal diseases and complications were assessed before surgery .Stent removal & esophageal repairing ( n=6) ,esophageal carcinoma resection plus cer‐vical esophageal externalization ( n =5) ,esophageal carcinoma resection plus gastroesophagostomy ( n =5) and an exclusion of thoracic esophagus & diversion (colon interposition ,n=5) were performed .The remaining 1 pa‐tient underwent .exclusion of esophageal and tracheal defects and stent removal .[Results] No instance of major complication occurred except for anastomotic fistula ( n=1) .There was no mortality during the perioperative pe‐riod .Among 5 patients with esophageal cancer ,3 cases died after palliative surgery at 6 ,7 and 9 months respec‐tively ,one survivor after esophagogastrostomy died of an unrelated illness and another one was followed up .Ex‐cept for one patient with esophageal repairing ,the remainder resumed oral ingestion at 4 months after operation . During a follow‐up period of 4~141 months ,no fistulas occurred and their quality of life improved .[Conclusion]Surgery is a first choice for complications after esophageal stenting .Meticulous preoperative planning and individu‐alized surgical interventions are crucial steps in the management of esophageal complications .