外科治疗食管呼吸道瘘——附7例报道

Surgical treatment for esophagorespiratory fistula:a report of 7 cases

背景与目的：食管呼吸道瘘常存在危及生命的肺部感染，临床上处理较棘手，虽经内科保守治疗或支架介入治疗可短期控制肺部感染，但患者的生活质量低，总生存期短。该研究旨在探讨食管呼吸道瘘外科治疗的手术效果及安全性。方法：回顾性分析河南省胸科医院2009年6月-2013年10月外科治疗7例食管呼吸道瘘患者的临床资料。致瘘原因为食管癌4例，先天性1例，食管憩室1例，外伤性1例。7例患者均行开胸手术治疗，其中食管部分切除（胃代食管）＋肺叶切除2例；食管部分切除（胃代食管）＋气管瘘口修补1例，残胃瘘口修补＋肺叶切除1例，食管瘘口修补＋肺叶切除2例，食管气管瘘与瘘管双重结扎1例。结果：围手术期无死亡情况发生。术后并发症发生率为57％（4／7），2例术后并发严重肺部感染；1例术后出现食管胃吻合口气管瘘，择期行空肠造瘘；1例术后并发胸腔感染。6例患者恢复后均经口正常进食。术后随访：3例良性病变患者1年无复发；4例恶性病变患者平均生存时间为18．8个月（11—28个月）。结论：良性食管呼吸道瘘一旦确诊，应积极行手术治疗；恶性食管呼吸道瘘依据患者病情和体质选择手术治疗，改善生活质量，延长生存时间。

Background and purpose： Esophagorespiratory fistula is often accompanied with life-threatening pulmonary infection. Though the pulmonary infection can be controlled temporarily by conservative medical treatment or stent placement, but patients have a poor quality of life and short survival time. This study was to investigate the effectiveness and security of surgical treatment for patients with esophagorespiratory fistula. Methods： We retrospectively analyzed the clinical data of 7 patients with esophagorespiratory fistula after surgical treatment between Jun. 2009 and Oct. 2013 in Henan Province Chest Hospital. The causes were the following： esophageal cancers （4 cases）, congenital fistula （1 case）, diverticulum （1 case） and trauma （1 case）. All patients underwent surgical treatment through thoracotomy. Surgical treatment consisted of esophagectomy gastroesophageal anastomosis and pulmonary lobectomy in 2 patients, esophagectomy gastroesophageal anastomosis and tracheal fistula repair in 1 patient, remnant stomach repair and pulmonary lobectomy in 1 patient, esophageal fistula repair and pulmonary lobectomy in 2 patients and esophagotracheal fistula double deligation in 1 patient. Results： There was no perioperative death. The incidence rate of postoperative complications was 57% （4/7）. Two patients got severe pulmonary infection. One patient suffered from esophageal-tracheal fistula recurrence and underwent elective jejunostomy. One patient had thoracic cavity infection. Six patients resumed normal eating after postoperative recovery. Follow-up was acquired in all cases. Three cases with benign fistula remained well without recurrence. Four cases with malignant fistula had an average survival time of 18.8 months （11-28 months）. Conclusion： Once congenital esophagorespiratory fistula is confirmed, surgical management is recommended as early as possible. The selective surgical treatment for malignant esophagorespiratory fistulas according to patient＇s condition could improve the life quality and lengthen the survival time.