成人先天性食管支气管瘘的诊断及外科治疗

目的 探讨成人先天性食管支气管瘘的临床诊断及外科治疗.方法 回顾性分析1990年5月至2010年8月确诊并手术的11例成人先天性食管支气管瘘患者的临床资料.其中男性7例,女性4例,年龄28～66岁,平均48.7岁.主要临床表现为间断咳嗽、咳痰10例,进流食呛咳6例,咯血6例,长期反复肺部感染伴低热4例,胸痛3例.病史5～36年,平均16.8年.本组患者术前均经食管造影,或同时结合食管镜、支气管镜检查证实为食管支气管瘘,术后病理进一步确诊.6例行右下肺叶切除术,1例行右中下肺叶切除术,3例行左下肺叶切除术,1例行左全肺切除术,瘘管的食管残端均经结扎、缝扎等处理.结果 10例术后痊愈出院,住院时间10～18 d,平均12.3 d.1例术后第8天发生食管瘘,经再次手术后治愈.术后11例患者均定期随访.3年生存率11/11,5年生存率9/11.结论 成人先天性食管支气管瘘临床少见,容易误诊,多体位食管造影是确诊的主要手段;外科手术是惟一的治愈方法.

Diagnosis and surgical treatment of congenital bronchoesophageal fistula in adult

Objective To explore the clinical characteristics, diagnosis and surgical treatment of adult congenital bronchoesophageal fistula. Methods Eleven cases of adult congenital bronchoesophageal fistula that were diagnosed and surgically treated between May 1990 and August 2010 had been reviewed.There were 7 male and 4 female patients, ranging in age from 28 to 66 years (mean 48. 7 years). The chief clinical presentation included coughing and sputum in 10 cases, recurrent bouts of coughing after drinking liquid food in 6 cases, hemoptysis in 6 cases, low fever in 4 cases, chest pain in 3 cases. The duration of symptoms before diagnosis ranged from 5 to 36 years ( mean 16. 8 years ) . The diagnosis of bronchoesophageal fistula was confirmed most by esophagography. Associated diseased lung was resected in all patients ( lobectomy in 10 cases and pneumonectomy in 1 case) . The operation included right thoracotomy in 7 cases and left thoracotomy in 4 cases. The fistula was completely resected in 10 cases. The tract was simply divided and the end was sutured in 1 case. Results The postoperative course was uneventful in 10 patients who were discharged from hospital 10 to 18 d after operation. One patient suffered from esophageal fistula and received second operation. Regular follow-up was conducted on all 11 patients,proving that 3-year survival rate was 11/11 and 5-year survival rate was 9/11. Conclusion Persistence of congenital bronchoesophageal fistula into adulthood is rare. The main symptom is nonspecific coughing and bouts of coughing after drinking liquid food. The most useful diagnostic method is the esophagography. Even though it is benign disease, life-threatening complications might occur and it must be treated surgically as soon as the diagnosis is established.