良性获得性气管食管瘘的治疗

目的 探讨良性获得性气管食管瘘的治疗方法.方法 回顾分析13例良性获得性气管食管瘘的临床资料并复习有关文献.全组均手术治疗,其中彻底性手术10例(气管食管瘘切除、气管食管瘘口分别修补7例,气管食管瘘切除、食管瘘口修补、病变气管切除端端吻合3例),姑息性手术3例.结果 围手术期无死亡病例.发生肺部感染2例,无其他并发症发生.除1例末行消化道重建的多发瘘患者外,余者术后3个月内均恢复经口摄食.随访8～73个月,行瘘修补的患者无瘘再通发生,行瘘旷置患者瘘口均较前缩小或基本愈合.结论 慎用食管或气管支架.外科手术是最佳治疗方法.有效阻隔、充分引流胃液是治疗成功的关键因素.     

带蒂背阔肌肌皮瓣治疗获得性气管食管瘘合并气管皮肤瘘一例

1例56岁男性患者,因脑外伤行去骨瓣减压术,术后机械通气治疗30+d,气切套管拔除后发现气管食管瘘合并气管皮肤瘘并转入我院.我们进行了气管切除术加食管瘘口修补术,并在气管前方与食管前方予以带蒂背阔肌肌皮瓣修补.患者术后24 d顺利出院行后续神经康复治疗,出院时可正常经口进食.     

新生儿食管闭锁及气管食管瘘的麻醉管理

新生儿食管闭锁及气管食管瘘因手术操作需要压迫右侧肺,造成左肺单肺通气(OLV),麻醉管理困难。现将我院20例新生儿食管闭锁及气管食管瘘麻醉管理总结如下:     

新生儿食管闭锁并气管食管瘘的麻醉处理

先天性食管闭锁(esophagcal atrcsia，EA)并气管食管瘘(tracheo esophageal fistula，TEF)的患儿常合并肺部感染和循环衰竭，手术死亡率较高。近4年来我科共实施10例此类手术的麻醉，效果满意。现将麻醉管理总结如下。     

可回收Sigma支架治疗继发性气管食管瘘

目的探讨可回收Sigma支架治疗气管食管瘘的可行性和优越性。方法用介入或内镜两种方法，为19例病人将支架置入食管或（和）气管内，封堵瘘口。结果17例食管癌、2例良性疾病病人，共放38个支架（气管19个，主支气管1个，食管18个）。2例仅放1个气管支架，15例放双支架（均为管形11例，气管用分叉形4例），2例放3个支架。1次放置成功35个，取出重放3个。放置后第2～4d正常经口进食。除1例仅放置气管支架者，术后有少量造影剂渗入气管，但没有症状，其余18例造影显示气管食管瘘完全封闭。随访3个月至3年，10例健在，最长已18个月。9例死亡，生存2周至12个月，中位生存5．8个月。死于肺部感染1例、大出血1例、肿瘤广泛转移7例。结论可回收Sigma支架通体覆膜，因管口与管身直径一致，克服了记忆合金支架的金属喇叭口明显刺激管壁肉芽增生狭窄，该支架易于回收，可保证放置准确。能有效治疗良、恶性疾病造成的气管食管狭窄和气管食管瘘。     

覆膜食管支架治愈外伤性食管气管瘘4例

外伤性食管气管瘘是胸外科难治的疾病之一。我们用覆膜镍钛合金支架治疗 4例 ,效果良好 ,现报道如下。临床资料　本组中男 3例 ,女 1例 ;年龄 35～ 4 8岁 ,平均4 1岁。车祸和高处坠落伤各 2例。临床均表现为受伤后早期饮水及吞咽出现呛咳。Ｘ线胸片提示双肺下部炎症。食管碘油造影见造影剂通过食管气管瘘口进入气管。胃镜下可见食管与气管相通的瘘口 ,0 8～ 2 0ｃｍ大小。分别于伤后 3、5、11、4 5ｄ放置支架。首先在胃镜下测量瘘口距门齿距离、瘘口大小及在食管上的具体方位 ,然后将支架置放器与胃镜捆绑式放入食管 ,在直视下松开捆绑线 …     

成人良性食管气管支气管瘘的诊断和治疗

１９６０－１９９１年作者共收治良性食管气管瘘和食管支气管瘘患者２６例，多为外伤或憩室所致。手术治疗２３例，术后均恢复正常进食。为避免肺部并发症，此病一俟诊断明确即应尽早手术。食管瘘和气管、支气管瘘分别修补后用胸膜或肌瓣间置可有效地预防复发。本文还报告２例罕见的巨大食管气管瘘的治疗经验。     

医源性气管、支气管食管瘘的外科治疗

目的 探讨医源性气管、支气管食管瘘的病因及外科治疗方法,为临床治疗提供经验. 方法 1995年1月至2008年12月上海市胸科医院及上海市第六人民医院共收治气管、支气管食管瘘患者21例,其中医源性12例,男8例,女4例;年龄35～74岁,平均年龄47岁.原发病主要为肿瘤,在治疗原发病21 d～5年后发生瘘,其中气管食管瘘2例,支气管食管瘘10例;右侧支气管瘘6例,左侧支气管瘘4例.采用单纯瘘管切除、气管或支气管及食管瘘口修补2例,肺叶切除、食管瘘口修补5例,气管瘘修补或全肺切除合并消化道重建5例. 结果 全组无手术死亡,术后发生并发症2例,均治愈,无术后复发.12例患者术后均随访1年,无气管、支气管食管瘘发生. 结论 医源性气管、支气管食管瘘病情复杂、严重,手术是最有效的治疗手段.     

新生儿先天性食管闭锁/气管食管瘘麻醉策略的改进

新生儿先天性食管闭锁／气管食管瘘（EA／TEF）修复术，麻醉中容易发生消化道胀气、肺通气不足，甚至反流误吸。麻醉管理重点在于良好的肺通气，避免瘘口通气。     

Diagnosis and treatment of congenital isolated tracheoesophageal fistula

The specific features of the diagnosis, clinical picture, and treatment of congenital isolated tracheoesophageal fistula are described. The informativeness of esophagography with limitation of the esophageal area with obturators in noted left cervical oblique-transverse supraclavicular approach is optimal for operative separation of the fistula. One child who did not undergo operative treatment died from severe: aspiration pneumonia.     

Management of acquired nonmalignant tracheoesophageal fistula

Acquired, nonmalignant tracheoesophageal fistula is an uncommon and difficult problem to manage. The most common cause is a complication of endotracheal or tracheostomy tubes. Most are diagnosed while patients still require mechanical ventilation. We use a conservative approach until patients are weaned from ventilation. A tracheostomy tube is placed so that the balloon rests below the fistula, if possible, to prevent contamination of the tracheobronchial tree. A gastrostomy tube is placed for drainage and a separate jejunostomy tube for nutrition. Single-stage repair is done after the patient is weaned from mechanical ventilation. Esophageal diversion is rarely required. We have performed 41 operations on 38 patients. Simple division and closure of the fistula was done in 9 patients and tracheal resection and reconstruction in the remainder. The esophageal defect was closed in two layers and a viable strap muscle interposed between the two suture lines. There were four deaths (10.9%). There were three recurrent fistulas and one delayed tracheal stenosis. All were successfully managed. Of the 34 surviving patients, 33 aliment themselves orally and 32 breathe without the need for a tracheal appliance.     

Diagnosis of H-type tracheoesophageal fistula

A study was made of the diagnostic aspects of 11 cases of congenital tracheoesophageal fistula without atresia (H-fistula) seen in the 17 years 1971 through 1988. The features of aspiration with feeding were present from birth in all cases, and yet the diagnosis was often delayed. The results emphasise the complimentary diagnostic roles of contrast esophagogram and rigid open-tube endoscopy. The latter not only yields a high diagnostic rate but is necessary for evaluation of associated congenital anomalies of the aerodigestive tract.     

成人先天性食管呼吸道瘘的诊断和治疗

目的 探讨成人先天性食管呼吸道瘘的诊断和治疗经验.方法 回顾性分析1990年1月至2007年11月第四军医大学唐都医院收治的6例成人先天性食管呼吸道瘘的临床资料.本组患者均有饮水和(或)进流质饮食呛咳、咳嗽、咳痰的临床表现.确诊后行食管呼吸道瘘切断缝扎+食管修补+带蒂胸膜加固术.结果 结合病史和影像学检查6例患者均术前确诊,手术探查发现瘘管位于食管气管膜部3例,食管右肺下叶背段2例,食管左肺下叶内基底段1例.直径为0.3～1.0 cm,长度为0.2～1.5 cm.手术治疗效果良好.随访5个月至10年,未见复发.结论 对于反复发作的慢性咳嗽和肺化脓症要考虑到先天性食管呼吸道瘘的可能,综合临床表现及影像学检查可以确诊.手术治疗效果较好,无复发.     

Diagnosis of tracheoesophageal fistula by radioscanning

Current techniques for the detection of “H-type” tracheoesophageal fistula are cumbersome and inaccurate, and most require anesthesia. We have devised a rapid, noninvasive diagnostic method that detects the diffusion of an inert, radiolabeled gas across the fistula. ¹³³Xe is introduced and retained in the esophagus by means of a Foley catheter. During insufflation, the neck and chest are imaged by a scintillation camera and the radioactivity is recorded and displayed in counts per second. In control dogs, the gas remained in the esophagus and the level of activity decreased at an average rate of 7.5 counts/sec due to tissue absorption. In dogs with surgically created fistulas there was a rapid loss of activity as the gas diffused across the fistula into the trachea and was exhaled. The loss was directly proportional to the area of the fistula. After subtracting the component due to tissue absorption, a 2-mm fistula gave a loss at a rate of 8.2 counts/sec, a 5-mm fistula at 47 counts/sec, and an 8-mm fistula at 125 counts/sec. Although these results are only preliminary, the technique appears to be useful in the diagnosis of congenital tracheoesophageal fistula as well as acquired fistulas resulting from endoctracheal tubes, neoplasms, and trauma.     

Management of acquired tracheoesophageal fistula with various clinical presentations

Purpose

To determine the best therapeutic approach for acquired tracheoesophageal fistulae in childhood by evaluation of distinct clinical presentations requiring different surgical management based on our clinical experience.

Patients and Methods

Seven patients with acquired tracheoesophageal fistula seen between 1999 and 2010 were retrospectively studied with regard to the presenting findings, diagnostic evaluation, therapeutic approach, and outcomes.

Results

Five girls and two boys with a median age of 36 months (range, 2-156 months) were treated for acquired tracheoesophageal fistula. The presenting symptoms were respiratory difficulty (n = 3), coughing (n = 2), and dysphagia with coughing (n = 2), with a median duration of 30 days (range, 1-730 days). The etiologies were disc battery ingestion (n = 3), placement of endoesophageal prosthesis for caustic esophageal stricture (n = 2), corrosive ingestion with extensive burn (n = 1), and blunt chest trauma with subsequent emergency tracheotomy (n = 1). The site of the fistulae were proximal (n = 3) and middle (n = 1) trachea, left main bronchus (n = 1), and nearly the entire posterior wall of the trachea (n = 2). The patients were variously managed: conservatively with eventual spontaneous closure (n = 1), primary repair (n = 2), and colon interposition after cervical esophagostomy (n = 4) based on the clinical evaluation on admission and the follow-up status. Stenosis of the proximal esophagus (n = 2) and esophagocolonic anastomosis (n = 2) were the only complications encountered after treatment and were successfully managed with dilatation.

Conclusions

The best therapeutic approach for acquired tracheoesophageal fistula can be determined with careful consideration of relevant parameters on admission, including medical history, presenting findings, etiology, and characteristics of the fistula, in addition to the clinical evaluation in the follow-up period. In general, conservative management should precede definitive surgical intervention both to allow for possible spontaneous closure and also to achieve optimal preoperative status. Primary repair or a staged surgical approach can be best selected by giving priority to the patient's airway security.     

Anesthetic management of acquired tracheoesophageal fistula: a brief report

IMPLICATIONS: Tracheoesophageal fistula may be either a congenital lesion or an acquired condition, most often resulting from foreign body ingestion. Location of the lesion has implications for anesthetic management and single lung ventilation may be required to facilitate surgical repair. In pediatric patients, intentional mainstem intubation may be required.