恶性食管气管瘘的治疗

Treatment of Malignant Esophago-tracheal Fistula

目的 :报告 7例恶性食管气管瘘的治疗经验。方法 :气管环行切除对端吻合同期食管癌根治胃代食管颈部吻合术 4例 ;食管癌旷置银夹置标胃代食管颈部吻合术 2例 ;用带蒂大网膜分别修补瘘口术 1例。术后 4～ 6周根据银夹标记及纵隔淋巴结癌转移者共 4例行6 0 Co放射治疗 ,总量 5 0～ 6 0Gy/5～ 7周。结果 :术后 1周均可正常经口进食 ,肺部炎症消退 5例 ,好转 2例 ,术后 4周体重平均增加 2 0 8kg。生存 1年 7例 ,3年 4例 ,5年以上 2例。结论 :对于肿瘤组织仅侵犯食管气管而无远处转移 ,肺功能又能胜任开胸手术的病例 ,积极手术治疗能提高患者生活质量 ,延长生存期 ,同时为放。

Objective To report experiences on the treatment of 7 cases with malignant esophago tracheal fistula.Methods Tracheal circular resection through end to ent anatomosis plus homochronous radical Operation for esophageal carcinoma by means of cervical esophagogastrostomy were given go 4 cases.Operation was given to 2 cases with esophageal carcinoma by means of cervical esophagogastrostomy and by indwelling silver clips as marks.Fistula repairment was given to 1 case by using pediculated greater omentum. 60 Co radiotherapy was given to 4 cases with mediastinal metastasis of lymph node according to the silver clip marks 4-6 weeks after operations with a total amount of 50-60 Gy for 5-7 weeks.Results All the 7 cases were perorally fed 1 week after operation,and resolusion of lung inflamation occured in 5 cases,clinical conditions improved in 2 of the 7 cases.The average weight gain 4 weeks after operation was about 2 08 kg.The survival time was 1 year for 7 cases,3 years for 4 cases and 5 for 2 cases.Conclusions Active operation can improve patient's living quality,prolong their survival time and pave the way of radio chemotherapy when tumor tissue invassion is limited within certain area of esophagus and trachea and without remote metastasis and when patient's lung functiou is good enough for thoracotomy.