成人食管气管支气管瘘的外科治疗(附7例报告)

Surgical Treatment of Bronchoesophageal fistula

成人食管呼吸道瘘临床上很少见。上海市胸科医院１９６８～１９９３年间共收治成人先天性食管呼吸道瘘７例，其中男６例，女１例。年龄在２５～４８岁之间，最小５岁即出现症状，最大到４２岁才首发症状。主要临床表现是进食呛咳，但往往缺乏典型症状。食管钡剂造影有确诊价值，纤维支气管镜及食管镜能帮助诊断。治疗以瘘管切除为首选方法，部分病例因肺不可逆损伤需同时行病肺切除术。作者强调，确诊成人食管呼吸道瘘是先天性或获得性的主要方法是术后病理——瘘管具有鳞状上皮或柱状上皮粘膜及粘膜下肌层。

Objective:To summarize the experience of surgical management of congenital bronchoesophageal fistula (BEF) and tracheoesophageal fistula (TEF),rarely seen in adults.Clinical material and method: Seven patients,6 men and 1 woman and 6 with congenital BEF and 1 with TEF,were treated surgically.Their age ranged from 25 to 48 years old.The main clinical manifestation is irritable cough after meal especially after swallowing of liquid food.The fistula were confirmed in all of them by barium esophagogram.The surgical procedures performed consisted of resection of the fistula in 4 cases and resection of the fistula together with lobectomy in 3.The tracts of the resected fistula were measured 0.8-0.2cm in length and 0.5-1.2cm in diameter and covered by squamous epithelial cells with submucosal muscular layer.Result: All patients recovered from surgery uneventfully.Conclusion:Both BEF and TEF should be treated surgically as early as possible if patient's condition allows.The histologic components of the fistula wall are the specific evidence to differentiate the congenital origin from the acquired.