外科重建治疗获得性食管气管-支气管瘘(附8例报告)

目的探讨获得性食管气管-支气管瘘的病因、诊断及外科处理原则。方法对我科及南方医院胸外科自1997.8-2005.7共收治8例食管呼吸道瘘的病例进行回顾性分析。术前诊断主要靠食管钡餐;位置和大小主要靠气管镜和食管镜。薄层CT扫描也具有较好诊断价值。全组采用的手术方法有三种:1.食管、气管分别修补术;2.胸膜或带蒂肌瓣封闭瘘口术,胸骨后结肠或胃代食管;3.食管支气管瘘加下肺叶切除、食管重建术。结果全组接受手术治疗者7例全部治愈出院;颈部食管结肠吻合口瘘出现1例,全部病例均随访。4例良性病变所致瘘病人均存活。恶性病变所致3例均于术后3-6月死亡,主要死因是肿瘤扩散致多器官衰竭。未接受手术治疗者1例死亡。结论外科干预是获得性食管气管-支气管瘘的首选治疗。根据不同的病人选择不同的术式去重建食管和气管的连续性,才可取得良好的效果。

Surgical reconstruction for the treatment of the acqired esophagotracheo-bronchial fistulas (A report of 8 cases)

Objective To investigate the cause,diagnosis and principle of surgical treatment for the acquired esophagotracheo-bronchial fistulas.Methods From August 1997 to July 2005,8 cases with esophagotracheo-bronchial fistulas were analyzed retrospeetively.Results Postoperative complications:esophago-colonic anastomotic fistula of neck was found in one case.Among them,7 cases received operation were cured to discharge from hospital and 1 case died from given up treatment.Follow-up was gotten in all cases.4 cases with benign lesion resulting in fitula were survival.3 cases with malignant lesion resulting in fistula were death 3 to 6 months after operation and the main cause of death was multiple organ failure resulting from tumor disffusion.Conclusion Surgieal intervention is first choice for the treatment of acquired esophagotracheo-bronchial fistulas.According to the patient's different condition,the different procedures should be selected to reconstruct the continuity between esophagus and trachea or bronchus.