食管癌切除术后胸胃-气管／支气管瘘的防治经验与教训  

Experience on the diagnosis and treatment of intrathoracic gastro-airway fistulae after esophagectomy for esophageal carcinoma

作　　者：左晓飞[1] 牛中喜[1] 时辉[1] 胡杨[1] 王允[1] 陈龙奇[1] 

机构地区：[1]四川大学华西医院胸外科,成都610041

出　　处：《中华胸心血管外科杂志》2013年第3期132-135,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结食管癌切除、管状胃代食管术后并发胸胃-气管／支气管瘘的原因、诊断、预防及治疗经验。方法2010年1月至2012年2月共应用管状胃代食管技术治疗食管癌手术切除食管癌1490例，发生胸胃-气管／支气管瘘10例，总发生率为0．67％，其中5例死亡。复习患者临床资料，总结分析瘘的发生原因、特点、治疗方法及预防措施。结果胸胃-气管／支气管瘘发生于左主支气管7例，气管远段2例，右支气管1例。首选内镜治疗8例，3例治愈，5例堵瘘失败者中2例死亡，3例行择期手术治疗，其中1例治愈，2例死亡；1例直接行手术治疗治愈；1例放弃治疗死亡。结论胸胃-气管／支气管瘘与手术操作损伤及管状胃切缘缝合材料磨损气管／支气管壁等因素有关，而严密缝合及妥善包埋胃小弯切缘、用人工材料或大网膜隔开支气管将有效减少胸胃气管瘘的发生，食管支架在管状胃内完全封闭瘘口有困难仅适于瘘口距吻合口较近的患者，气管支架可改善生活质量但很难使瘘口愈合，手术是最有效彻底解决问题的方案，以同期修补重建为佳，但要严格掌握指征。Objective To summarize our resuhs and experience in dealing with the postoperative intrathoracic gastro-air- way fistulae after esophagectomy for esophageal carcinoma. Methods From January 2010 through February 2012, 1490 pa- tients with esophageal carcinoma underwent esophagectomy in our department. The postoperative intrathoracic gastro-airway fis- tulae were documented in 10 patients, with a frequency of 0.67%. Five of them died. The possible etiology, clinical charac- ters, treatment and prevention of this complication were reviewed. Results The location of the fistulate were 7 at left main bronchus, 1 at right main bronchus, and 2 at distal trachea. After 2 - 3 weeks conservative treatment, 1 patient underwent pri- mary surgical repair and cured, 1 refused any further intervention and sacrified, 8 patients underwent endoscopic insertion of covered stent and only 3 healed. For the remaining 5 cases with failed stem therapy, 2 died of severe aspiration and lung infec- tion, 3 had surgical repair, one of them successed and 2 died of aspiration and aortic rupture, respecively. Conclusion The development of intrathoracic gastro-airway fistulae was associated with the iatrogenic injuries and suturing material irritation of the gastric tube to the tracheaL/bronchial wall. Therefore, a meticulous closure and wapping of gastroplasty and appropriate iso- lation using artifical patch or great omentum between airway and esophageal substitution could effectively reduce the fistulae. The stent therapy usually fails in treating this entity and surgical repair remains the final and ratical therapeutic option. Primary repaire is suggested and careful preoperative assessment is crucial.

关 键 词：食管肿瘤 食管切除术 支气管瘘 支架置入 

分 类 号：R735.1[医药卫生—肿瘤]