颈段气管食管瘘合并喉气管狭窄的诊治经验  

Experience of diagnosis and treatment for cervical tracheoesophageal fistula complicated with laryngotracheal stenosls

作　　者：陈文弦[1] 阮炎艳[1] 崔鹏程[1] 高鹏飞[1] 罗家胜[1] 刘志[1] 

机构地区：[1]第四军医大学唐都医院耳鼻咽喉科,西安710038

出　　处：《中华耳鼻咽喉头颈外科杂志》2009年第2期114-117,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨颈段气管食管瘘合并或遗留喉气管狭窄及颈前瘘的治疗方法与经验教训。方法回顾分析第四军医大学唐都医院1980至2007年收治各种原因引起的颈段气管食管瘘14例，其中9例合并或遗留喉气管狭窄，3例合并喉气管狭窄及颈前巨瘘，2例为食管狭窄用镍钛合金网支撑引起颈段气管食管瘘。根据不同病情分别采用喉气管狭窄成形术时食管气管瘘保守治疗；分期修复气管食管瘘、喉气管狭窄及颈前巨瘘。结果4例气管食管瘘口较小者（长径2—3mm）在喉气管成形术时喉气管腔内置入硅橡胶T型管，气管食管瘘保守治疗，食管气管瘘及喉气管狭窄全部治愈。6例气管食管瘘较大者（长径10～25mm），其中3例合并喉气管狭窄及颈前瘘，2例仅合并喉气管狭窄者，1例因镍钛合金网支撑引起气管食管瘘无合并症者采用分期修复气管食管瘘、喉气管狭窄及颈前巨瘘。这6例气管食管瘘及喉气管狭窄，颈前巨瘘全部痊愈。2例气管食管瘘入院前经保守治疗已治愈，仅遗留喉气管狭窄，经喉气管成形术后治愈。以上12例经1—10年随访，食管气管瘘及喉气管狭窄未见复发，吞咽及呼吸功能基本保持正常。1例气管食管瘘合并喉气管狭窄术中见食管远端残端闭锁，只行喉气管成形术及瘘口缝合，治愈后，转胸科行胃代食管治疗治愈。1例食管狭窄用镍钛合金网支撑形成气管食管瘘于喉气管腔内置入硅橡胶T型管，合金网未取出，最终因损伤气管膜部血管出血造成窒息死亡。结论治疗颈段小的气管食管瘘合并或遗留喉气管狭窄可在喉气管成形术同时采用保守治疗，瘘口大需分期手术修复气管食管瘘及喉气管狭窄。Objective To explore the treatment of cervical tracheoesophageal fistula （TEF） with complicated or remnant laryngotracheal stenosis （LTS） and anterior neck defect （AND）. Methods From 1980 to 2007,14 patients were diagnosed as TEF. Among them, 9 patients had complicated or remnant LTS, 3 patients had complicated AND, and 2 patients had TEF which were induced by Nickel-Titaium alloy mesh stent for treating benign esophageal stricture. All these patients were retrospectively studied in Tangdu Hospital. Treatment consisted of conservative therapy of TEF, staged surgical repair of TEF and laryngotracheal reconstruction according to the dimension （small or large ） of TEF and complications. Results Four patients with small TEF （2 - 3 mm length ） complicated LTS underwent laryngotracheal reconstruction stented with silicone T tube and TEF was adopted conservative treatment. The TEF and LTS were healed. Six patients with larger TEF （ 10 - 25 mm length） were repaired by staged surgical repair of TEF and laryngotracheal reconstruction. Among them, 3 cases had complicated LTS and AND, 2 cases had rement LTS and 1 case had TEF without complication. Two patients had TEF and LTS, whose TEF healed before laryngotrucheal reconstruction, the remnant LTS were reconstructed and healed. During the follow-up ranged from one to ten years, 12 patients were successfully treated without complications. One patient with TEF and LTS was treated only LTS because of a segment of esophagus was closed and treated with esophugogastrostomy in the department of thoracic surgery after LTS was successfully reconstructed and cured. One patient died of bleeding and asphyxia induced by the Nickel-Titanium alloy stent because of the stent had not been taken out. Conclusion The small cervical TEF complicated or remnant LTS can be treated by laryngotracheal reconstruction and conservative treatment of TEF at the same time. A larger TEF complicated LTS should be treated by staged repair of TEF and LTS.

关 键 词：气管食管瘘 喉狭窄 气管狭窄 皮瘘 外科手术 

分 类 号：R686[医药卫生—骨科学]