5例胸胃支气管瘘诊治经验分析  

Diagnosis and treatment experience of thoracostomach-bronchi fistula in 5 cases

作　　者：姜建青[1] 郑琇山[1] 俞永康[1] 刘宝玉[1] 郑轶峰[1] 李卫[1] 杨列[1] 贺波[1] 

机构地区：[1]成都军区总医院胸外科,成都610083

出　　处：《西南国防医药》2013年第7期734-735,共2页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的总结5例食管癌术后并发胸胃支气管瘘诊治经验,并探讨术中预防策略。方法回顾性分析2009年6月～2012年6月5例食管癌切除术后并发胸胃支气管瘘患者临床资料,对支气管瘘发病特点、治疗方式进行总结。结果胸胃支气管瘘发生率0.58%(5/862),病死率0.12%(1/862)。早期瘘1例,发生于术后第3 d,行气管、食管瘘口修补术,术后第3 d因严重肺部感染、呼吸衰竭死亡;晚期瘘4例,发生于术后第10～17 d,经带膜支气管支架封堵气管瘘口、严格禁食水、肠内营养、胃肠减压、强力抑酸、抗感染等保守治疗痊愈出院。结论以带膜支气管支架封堵气管瘘口为主的保守治疗,对胸胃支气管瘘疗效肯定。Objective To summarize the diagnosis and treatment experience of thoracostomach-bronchi fistula in 5 cases,and to discuss the intraoperative preventative countermeasures.Methods A retrospective analysis of clinical data was made in 5 patients with the complication of thoracostomach-bronchi fistula after esophageal carcinoma resection between June 2009 and June 2012.The formative features of bronchi fistula and the treatment methods were summarized.Results The incidence of thoracostomach-bronchi fistula was 0.58%（5 /862）,and the mortality was 0.12%（1 /862）.Early fistula occurred in one patient on day 3 after the operation.The patient received the neoplasty of tracheal fistula orificium and easophagostoma but died of serious pulmonary infection and respiration failure on day 3 after the operation.Fistula of advanced stage occurred in 4 cases on day 10-17 after the operation.Those patients were cured after the conservative treatment such as the closing of tracheal fistula orificium by airway covered stent,strict inhibition of diet and water,enteral nutrition,gastrointestinal decompression,acid suppression,and anti-infection,etc.Conclusion The conservative treatment based on the closing of tracheal fistula orificium by airway covered stent has a positively curative effect on thoracostomach-bronchi fistula.

关 键 词：支气管瘘 支气管支架 治疗 

分 类 号：R655[医药卫生—外科学]