食管胸膜瘘29例的处理

Experience of twenty nine cases of esophagopleural fistula

目的总结我院食管胸膜瘘的处理体会,提高其在临床的诊治疗效。方法回顾性分析总结我院收治的29例食管胸膜瘘患者的治疗方法及其预后。结果29例病人中22例为原发食管破裂,7例为食管胃吻合口瘘。其中5例急症探查,5例中1例仅清创保守治疗延期痊愈,1例瘘口修补膈肌瓣覆盖失败,3例修补加胃底折叠覆盖,一期痊愈;19例保守治疗延期痊愈(其中1例保守治疗一个半月稳定,植入带膜支架漏出加重,半月后诱发大出血死亡);7例食管胃吻合口瘘者中,2例死亡,5例保守治疗延期痊愈。结论食管胸膜瘘的治疗中,若原发食管破裂发病<12 h、估计污染相对轻,宜早期行手术探查,胃底折叠修补为好。否则以"四管疗法"最为稳妥。

Objective To improve the diagnosis and treatment of esophagopleural fistula by reviewing the experience of esophagopleural fistula treatment. Methods The treatment and prognosis of 29 esophagopleural fistula patients were analysed retrespectivly. Results Among all the 29 cases,22 cases were esophageal rupture in which 5 cases underwent emergent surgeries, one case underwent debridgement and secondarily healed, one case was repaired by diaphragm muscle flap covering and failed to heal,3 cases were repaired by gastric fundus covering and primarily healed, 19 cases were treated with conservative methods and secondarily healed（ one case was clinical steady after one and a half months of conservative treatment ,and died of massive hemorrhage a half month after esophageal stentt implantation）. Seven cases were esophagogastrestomic fistulas,in which two cases died. Five cases were treated conservatively and secondarily healed. Conclusion In treating esophagopleural fistula, early surgery should be carried out to those time duration after esophageal rupture less than 12 hours and was mild contaminated. Repairing with gastric fundus is recommended. Otherwise the ＂four - tube＂ method is the most credible.