成人先天性食管呼吸道瘘的诊断和治疗

Diagnosis and treatment of congenital tracheoesophageal fistula in the adult

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0．3～1．0cm，长度为0．2～1．5cm。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。

Objective To investigate the diagnosis and treatment of congenital tracheoesophageal fistula （TEF） in adult patients. Methods The clinical data of 6 adult patients with congenital TEF who had been admitted to Tangdu Hospital from January 1990 to November 2007 were retrospectively analyzed. All patients had the symptoms of cough when drinking and/or eating fluid and expectoration. The fistulas of the 6 patients were excised, openings were closed with sutures, and the closures were covered with pedicled pleural flaps. Results All patients were diagnosed preoperatively according to the medical history and imaging examination. All the patients were with H-type TEF. The diameters of the fistulas ranged from 0.3 cm to 1.0 cm, and their lengths ranged from 0.2 cm to 1.5 cm. The outcomes and prognoses of the patients were excellent. All patients were followed up for 5 months to 10 years, and no recurrence occured. Conclusions Congenital TEF should be considered when patients are presented with recurrent and chronic cough and pulmonary suppuration. Congenital TEF can be diagnosed according to the medical history and imaging examination. Surgical procedure for congenital TEF is safe and effective.