食管代气管膜部治疗巨大食管气管瘘1例  

Paries Membranaceus Tracheae Replacement Using an Esophageal Segment for Repairing One Case of Huge Tracheoesophageal Fistula

作　　者：刘君[1] 殷伟强[1] 邵文龙[1] 黄俊[1] 何建行[1] 

机构地区：[1]广州医学院第一附属医院广州呼吸疾病研究所胸外科,广东广州510120

出　　处：《广州医学院学报》2008年第1期36-40,共5页Academic Journal of Guangzhou Medical College

摘　　要：目的:探讨巨大食管气管膜瘘的有效治疗新方法。方法:1例男性患者因车祸导致气管中段延续至隆突部气管后壁巨大缺口,完善CT、纤维支气管、胃镜等检查,行"食管中下段切除,胃经胸骨后上颈部,胃与食管颈部高位吻合术"修复巨大瘘口,术后随访1月。结果:相关检查发现缺口巨大、水肿、感染,缺口上下径约6.3cm,横径约2.4cm,相对应的食道前壁被腐蚀。该段气管与食管共腔、膨大,大小约6.3cm×4.5cm×3.7cm。另左主支气管后壁亦有一小缺口与食道前壁相通,缺口约0.6cm×2cm。予"食管中下段切除,胃经胸骨后上颈部,胃与食管颈部高位吻合术"治疗,术程顺利。随访示食管支气管瘘口后壁被部分胸段食管完整代替,瘘口消失,呼吸饮食恢复正常。结论:食管代气管修复巨大食管气管瘘可以顺利施行并可取得较好效果。Objective： To explore a new approach for effective repair of huge tracheoesophageal fistula. Methods： A male adult who suffered huge tracheoesophageal fistula from a traffic accident was referred. The deficit, located at the posterior wall of trachea, extended from the middle part of his trachea towards the level of carina, and communicated with the lumen of esophagus. After preoperative evaluation with CT, fibroptic bronchoscopy and gastroscopy, he received resection of medium and lower parts of the esophagus, repair of the tracheal deficit with and an entopic esophageal segment, and high gastro-esophageal anastomosis after diversion of stomach via retrosternal space towards the neck region. The patient had been followed up for 1 month so far. Results： Examinations showed a huge, edematous deficit with signs of infection, measuring 6.3 cm long and 2.4 cm in width. The anterior wall of esophagus immediately behind the deficit was missing, such that affected parts of trachea and esophagus shared a common cavity about 6.3 cm × 4.5 cm × 3.7 cm in size. In addition, a second small deficit （0.6 cm × 2 cm） was found in the posterior wall of left main bronchus, which also communicated with the anterior wall of esophagus. The operation was performed uneventfully. Follow-up at 1 month after surgery revealed complete closure of the fistula by part of thoracic esophagus. The patient resumed normal functions with breathing and eating. Conclusion： Paries membranaceus tracheae replacement using an esophageal segment for repairing huge tracheoesophageal fistula can be a safe and effective option for treatment of these patients.

关 键 词：食管气管瘘 电视辅助胸腔镜手术 胸外伤 

分 类 号：R655.4[医药卫生—外科学]