主动脉食管瘘并发上消化道大出血临床分析

Clinical characteristics of aortoesophageal fistula complicated with massive upper gastrointestinal hemorrhage

目的:分析主动脉食管瘘并发上消化道大出血患者的临床特征,以增加对该疾病的认识,争取早期手术治疗,改善患者预后。方法:回顾性分析北京协和医院2016年1月1日至2019年12月31日收治的5例主动脉食管瘘患者的临床表现、影像学及胃镜特点、治疗及随访情况。结果:5例患者中,男性4例,女性1例,年龄(58±8)岁,基础疾病包括动脉粥样硬化4例、高血压3例、高脂血症1例、主动脉瘤支架植入术后2例、风湿性心脏病心脏瓣膜置换术后1例。5例均并发呕血、低血容量性休克,其中4例曾出现前哨性出血,伴便血、胸痛、腹痛、胸闷等症状。CT增强扫描或主动脉CT动脉成像可见食管壁增厚、食管局部不连续、主动脉瘤样改变、主动脉支架周围气体影及造影剂外溢等表现。胃镜下可见食管凹陷性病变、深溃疡、黏膜糜烂伴出血表现。保守治疗及内镜下止血效果差,未经手术治疗的2例患者全部死亡。3例患者接受急诊开胸手术或主动脉腔内修复术,2例存活,1例围术期死亡。结论:主动脉食管瘘患者临床表现特异性欠佳,病情凶险,对有危险因素的患者应积极行CT及胃镜检查评估,及早诊断和及时手术是挽救患者生命的关键。

Objective To analyze clinical features of aortoesphageal fistula(AEF)patients with massive upper gastrointestinal hemorrhage.Methods Five AEF patients with massive upper gastrointestinal hemorrhage admitted in Peking Union Medical College Hospital from 2016 January 1st to 2019 December 31st.The clinical data,endoscopic findings,radiological manifestations,treatment and clinical outcomes were retrospectively analyzed.Results Among 5 patients,4 were males,1 was female with an average age of(58±8)years old.The underlying conditions were atherosclerosis(n=4),hypertension(n=3),hyperlipidemia(n=1);2 cases had aortic aneurysm stent implantation and 1 case of rheumatic heart disease had valve replacement.All 5 patients were complicated with hematemesis and hypovolemic shock,and 4 cases had sentinel hemorrhage.Contrast-enhanced CT or CT angiography of the aorta showed thicken esophageal wall,local esophageal discontinuity,aortic aneurysm,gas around the aortic stent and contrast agent spilling over.The gastroscopy showed esophageal depression lesions,deep ulcers,mucosal erosion with bleeding.Conservative therapy and endoscopic hemostasis failed,2 patients died without surgical intervention;3 patients underwent emergency surgeries,2 survived and 1 died perioperatively.Conclusions Aortoesophageal fistula is in lack of specific clinical manifestations but is highly in mortality.Therefore CT and gastrocopic examination should be performed for suspected patients,early diagnosis and surgical treatment are the key to save patients′lives.