食管癌食管支气管瘘的外科治疗  

Surgical Treatment of Esophagobronchial Fistula Induced by Esophageal Carcinoma

作　　者：雷杰[1] 张娜[1] 骆晴[1] 高坤祥[1] 杨恩德[1] 王小平[1] 

机构地区：[1]第四军医大学唐都医院胸腔外科,西安710038

出　　处：《中国胸心血管外科临床杂志》2012年第1期36-38,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的总结外科治疗食管癌食管支气管瘘的技术特点和经验,探讨安全、有效的治疗方案。方法回顾性总结第四军医大学唐都医院2007年1月至2010年11月收治12例食管癌食管支气管瘘患者的临床资料,男9例,女3例;年龄37～62岁,平均年龄51.24岁。根据不同病情,12例患者分别采取4种手术方式治疗食管支气管瘘(:1)食管部分切除+食管胃隧道式吻合术+肺叶切除术2例;(2)食管部分切除+食管胃器械吻合术+肺叶切除术5例;(3)食管部分切除+结肠代食管术+肺叶切除术4例;(4)食管部分切除+食管胃吻合术+左全肺切除术1例。结果围手术期死亡2例,病死率为16.67%(2/12),其中1例为食管癌侵及左肺下叶支气管,行食管部分切除+食管胃隧道式吻合术+左肺下叶切除术后第4 d死于心力衰竭;另1例为食管癌侵及左肺上叶支气管行食管部分切除+食管胃器械吻合术+左肺上叶切除术后第11 d死于重症感染伴肾功能衰竭。术后并发轻度脓胸4例,总并发症发生率为41.67%(5/12),并发支气管吻合口瘘1例,经抗感染、引流等治疗后愈合出院。随访1个月～3年,死亡1例;其余患者未出现明显并发症,无死亡。结论依据患者的病情,选择个体化手术方式,是临床治疗食管癌食管支气管瘘患者安全有效的治疗方案。Objective To summarize the technical characteristics and experience on the surgical treatment of esophagobrochial fistula induced by esophageal carcinoma and explore the safe and effective operation procedures.Methods This report retrospective1y summarized 12 cases of esophagobronchial fistula induced by esophageal cancer between January 2007 and November 2010 in Tangdu Hospital,Fourth Military Medical University.There were 9 male patients and 3 female patients with their mean age of 51.24 years（ranging from 37 to 62 years）.Four types of surgical procedures were performed to patients according to their respective conditions：（1） Esophagectomy ＋＂tunnel＂esophagogastrostomy ＋ pulmonary lobectomy（2 patients）;（2） Esophagectomy ＋ stapled esophagogastrostomy ＋ pulmonary lobectomy（5 patients）;（3） Esophagectomy ＋ colon interposition for esophagus ＋ pulmonary lobectomy（4 patients）;（4） Esophagectomy ＋ esophagogastrostomy ＋ left pneumonectomy（1 patient）.Results Among those 12 cases presenting to our hospital,2 patients died during the postoperative period and the overall morality was 16.67%（2/12）.One patient died of acute congestive heart failure on the 4th postoperative day after esophagectomy,＂tunnel＂esophagogastrostomy and left lower lobectomy of the lung for esophageal carcinoma directly invading the left lower bronchus,and another patient died of severe infection and renal failure on the 11th postoperative day after esophagectomy,stapled esophagogastrostomy and left upper lobectomy of the lung for esophageal carcinoma directly invading the left upper bronchus.Four patients developed mild empyema and 1 patient had bronchial fistula after surgery,who finally recovered and were discharged after treatment of antibiotics and drainage.The postoperative morbidity was 41.67%（5/12）.All surviving patients were followed up from 1 month to 3 years.During follow-up,there was one death,and the other patients were alive without any clinical events.Conclusion Individu

关 键 词：食管癌 食管支气管瘘 外科治疗 

分 类 号：R735.1[医药卫生—肿瘤]