获得性呼吸道消化道瘘的诊疗探讨

Diagnosis and Treatment of Acquired Respiratory-digestive Fistula

目的探讨获得性呼吸道消化道瘘的诊断和治疗方法。方法回顾性分析从2002年1月到2012年6月收治的10例获得性呼吸道消化道瘘患者的临床资料。结果 8例为恶性瘘,2例为良性瘘,其中支气管胸胃瘘5例,气管食管瘘3例,气管胸胃瘘和食管肺实质瘘各1例。7例采用手术治疗,其中6例采用带蒂软组织瓣修补,1例死亡,另外1例直接行瘘口修补;1例采用气管支架植入治疗,术后死亡;1例采用气管和食管双支架植入治疗;1例采用保守治疗,经十二指肠空肠营养管支持治疗。8例患者顺利出院并定期随访。结论带蒂软组织瓣修补是外科治疗获得性呼吸道消化道瘘的首选方法,同时可根据患者病情选择带膜支架植入治疗。

Objective To investigate the diagnosis and treatment of acquired respiratory-digestive fistula. Methods Clinical data of 10 patients who were diagnosed as having acquired respiratory digestive fistula and given different treatments between Jan. 2002 to Jun. 2012 were retrospectively analyzed. Results There were 8 malignant and 2 benign fistulas,including 5 broncho-gastric fistulas,3 tracheoesophageal fistulas, 1 tracheo-gastric fistula and 1 esophageal lung parenchyma fistula. Seven patients were surgically treated. Among them, 6 were managed by using pedicled soft tissue flaps with 1 death occurring,and one was treated by fistula repair. Moreover,one patient was treated with airway stenting,and died after treatment. One patient received double stenting for tracheoesophageal fistula. One underwent conservative therapy with placement of the duodenal feeding tube. Eight patients recovered smoothly and underwent follow-up on a regular basis. Conclusion Repair with pedicled soft tis- sue flaps is choice of surgical treatment for acquired respiratory-digestive fistula. Self-expandable coated stenting may be used in some patients when appropriate.