食管胸膜瘘的诊疗进展

Recent progress in the treatment and diagnosis of esophagopleural fistulas

食管胸膜瘘是指各种原因导致食管与胸膜腔异常沟通而形成瘘管,污染的消化液及食物残渣经纵隔进入胸腔,导致纵隔、胸腔和肺部的化学性炎症和细菌性感染。异物、外伤、感染、误服强酸、食管自发破裂、医源性损伤、肺切除、食管癌或贲门癌外科术后等原因都可能导致该病。临床上该病的发病率虽然不高,但因为瘘引发的进食障碍、水和电解质紊乱、胸腔顽固性感染和营养衰竭等并发症具有较高的病死率。早期诊断和及时正确的处理是提高治愈率和降低病死率的关键。本文就食管胸膜瘘的病因、病理与生理机制、临床表现、诊断及治疗进展作一综述。

Eesophagopleural fistula is defined as any fistula that is caused by abnormal communication between esophagus and pleural cavity due to various causes. Contaminated digestive fluids and food residues can enter the thoracic cavity through the mediastinum, leading to chemical inflammation and bacterial infection of the mediastinum, thoracic cavity and lungs. Foreign bodies, wounds, infection, strong acids taken by mistake, spontaneous rupture of esophagus, iatrogenic injuries, pneumonectomy, post-surgery of esophageal cancer or cardiac cancer, and other causes may lead to the formation of esophagopleural fistula.Clinically, the fistula-induced complications, including eating disorder, water and electrolyte disorder,intractable thoracic infection, nutritional failure, etc. carry a high mortality rate although the incidence of esophagopleural fistula itself is not high. Early diagnosis and timely, correct treatment are the key to improve the cure rate and reduce the mortality. This paper aims to make a comprehensive review about the esophagopleural fistula, focusing on its etiology, pathological and physiological mechanisms, clinical manifestations, and recent advances in its diagnosis and treatment.