纵隔淋巴结结核引起支气管食管瘘一例及文献复习

Bronchoesophageal fistula secondary to mediastinal lymph node tuberculosis： a case report and review of the literature

目的 分析1例纵隔淋巴结结核引起支气管食管瘘（bronchoesophageal fistula,BEF）的临床特征,以提高对该病的认识.方法 分析广州医科大学附属第一医院呼吸疾病研究所收治的1例BEF的临床表现、辅助检查及诊治过程,并结合文献进行回顾性分析.通过Pubmed数据库以“fistula”和“tuberculosis＂先后与“tracheoesophageal”、“bronchoesophageal＂和“esophagorespiratory＂联合搜索,至2012年10月31日共获取33篇相关文献.通过万方数据库对中文文献进行检索,检索词为“结核,气管食管瘘/支气管食管瘘”,至2012年10月31日检出相关文献报道1篇.结果 患者女,19岁,既往体健.因发热、饮水呛咳住院.经胸部CT,支气管管内超声引导纵隔淋巴结活检及口服美蓝试验确诊.通过抗结核治疗及留置胃管防止食物对瘘口的污染,BEF瘘口愈合.结论 纵隔淋巴结结核引起的BEF罕见.胸部CT、支气管镜检查及口服美蓝试验均为诊断BEF的有效方法.

Objective To analyze the clinical features of 1 case of bronchoesophageal fistula（BEF）secondary to mediastinal lymph node tuberculosis.Methods The clinical,auxiliary examinational and pathological data of 1 case with BEF were presented,and the literatures were reviewed.Results The patient was a 19 year old female,who was admitted to hospital because of fever and cough associated with liquid intake.It was diagnosed by chest CT scan,endobronchial ultrasound biopsy of mediastinal lymph nodes,and clinical testing （methylene blue）.The BEF was closed after anti-tuberculosis therapy and preventing contamination of the fistula by indwelling stomach tube.Conclusions Bronchoesophageal fistula secondary to mediastinal lymph node tuberculosis is rare.Chest CT scan,fiberoptic bronchoscopy,and clinical testing （methylene blue） are useful diagnostic tools for BEF.