非恶性食管-气管/支气管瘘的外科治疗

Surgical Treatment for Non-malignant Esophageal-tracheal/bronchial Fistula

目的探讨非恶性食管-气管/支气管瘘的临床特点和处理方法。方法回顾性分析2002年1月至2011年10月北京协和医院收治12例非恶性食管-气管/支气管瘘患者的临床资料,其中男6例,女6例;平均年龄49.8(32～72)岁。食管气管瘘7例,食管支气管瘘1例,食管癌术后胸胃支气管瘘2例,食管憩室支气管瘘2例。右侧开胸入路9例,左侧开胸3例。行食管瘘、气管瘘修补7例;食管瘘、支气管瘘修补1例;胸胃瘘、支气管瘘修补术2例;食管下段、左肺下叶切除,食管胃弓下吻合术1例;左肺下叶切除,食管憩室瘘修补术1例。结果全部患者均顺利恢复,无手术合并症或死亡,7～10 d恢复经口进食。术后3个月～1年内复查纤维支气管镜及上消化道造影,无气管支气管狭窄,无食管狭窄,不必采用支架或扩张治疗。术后随诊3个月～10年,均恢复良好。结论食管-气管/支气管瘘排除恶性病因,明确瘘口位置,术前给予充分营养支持,手术Ⅰ期修补瘘口,可以获得良好的治疗效果。

Objective To investigate clinical characteristics and surgical treatment of patients with non-malignant esophageal-tracheal/bronchial fistula.Methods We retrospectively analyzed clinical data of 12 patients with non-malignant esophageal-tracheal/bronchial fistula who underwent surgical repair in Peking Union Medical College Hospital from January 2002 to October 2011.There were 6 males and 6 females with a mean age of 49.8 years（ranging from 32 to 72 years）.There were 7 patients with esophagotracheal fistula,1 patient with esophagobronchial fistula,2 patients with gastro-bronchial fistula after esophagectomy for esophageal cancer,and 2 patients with esophageal diverticulum bronchial fistula.Nine patients underwent surgical repair via right thoracotomy approach,and 3 patients via left thoracotomy approach.Seven patients underwent esophageal fistula and tracheal fistula repair,1 patient underwent esophageal fistula and bronchial fistula repair,2 patients underwent gastric fistula and bronchial fistula repair,1 patient underwent esophagectomy,gastroesophageal anastomosis and left lower lobectomy,and 1 patient underwent esophageal diverticulum repair and left lower lobectomy.Results All the patients recovered well from surgery with no perioperative complication or in-hospital death,and resumed oral intake 7-10 days after surgery.Three months to 1 year postoperatively,regular examinations including upper gastroenterography and fibrobronchoscopy found no sign of tracheal/bronchial stenosis or esophageal stenosis,and no patients needed stent implantation or dilatation treatment.All the patients were followed up from 3 months to 10 years and had a good quality of life during follow-up.Conclusion Excluding malignant etiology and determining the exact fistula location are key points of clinical diagnosis for esophageal-tracheal/bronchial fistula.Adequate preoperative nutritional support and 1-stage surgical repair can lead to satisfactory clinical outcomes.