食管切除术后食管胃吻合口气管瘘的诊治

Diagnosis and therapeutic approach of fistulas between the esophagus and the respiratory tract after esophageal resection

目的：探讨食管切除术后食管胃吻合口（胸胃）气管瘘的诊治。方法：2008年6月~2010年10月间我们共手术治疗451例中段食管癌患者,对其中出现食管胃吻合口气管瘘的病例进行回顾性分析。结果：食管切除术后食管胃吻合口气管瘘的发生率为1.77%（8/451）,其发生与食管胃吻合口或胸胃瘘后纵隔感染腐蚀气管膜部相关。8例患者中3例行手术治疗,均治愈;5例行保守治疗（引流、抗感染及营养支持）,1例死亡,4例治愈,死亡率为0.22%（1/451）。结论：通过降低食管切除术后吻合口（胸胃）瘘的发生及减少术中气管膜部损伤可预防吻合口气管瘘的发生。针对不同病情选择恰当的治疗方法。

Objective：To investigate the diagnosis and therapeutic approach of fistulas between the esophagus and the respiratory tract after esophageal resection.Methods：Four hundred and fifty-one consecutive esophageal resections with middle esophageal cancer were reviewed to address the different therapeutic strategy in cases with esophagorespiratory fistulas from June 2008 to October 2010.Results：Eight（1.77%）patients developed esophagorespiratory fistula.The complication occurred by the mediastinal infection and succeeded corrosion of membranous part of trachea after esophagogastric fistula.Three patients cured by surgery.Four patients cured by chest drainage,decompression,anti-infective and nutritional support.One patient（0.22%）who did not have surgical operation died due to the fistula.Conclusion：Less incidence rate of esophagogastric fistula and less injuries of membranous part of trachea can be beneficial for preventing esophagorespiratory fistulas after esophageal resection.When an esophagorespiratory fistula is diagnosed,an attempt to close the fistula tract by proper therapeutic method can reduce the death rate and elevate the recovery rate.