食管癌术后消化道气管瘘的诊疗  

Diagnosis and Treatment of Gastrointestinal-Tracheobronchial Fistula after Esophagectomy

作　　者：沈宇舟[1,2] 茅腾[1,2] 陈文虎[1,2] 方文涛[1,2] 

机构地区：[1]上海交通大学医学院 [2]上海交通大学医学院附属胸科医院胸外科,上海200031

出　　处：《中国临床医学》2013年第3期305-308,共4页Chinese Journal of Clinical Medicine

摘　　要：目的:研究食管癌术后消化道气管瘘的诊断、治疗及预后。方法:回顾分析2008年1月—2012年5月1603例行食管癌手术患者的临床资料,其中发生消化道气管瘘者共14例,对这些病例的临床表现、诊断、治疗方法和预后进行统计和分析。结果:1603例食管癌手术中,消化道气管瘘14例(0.87%),病死6例(42.86%),肺部感染和呼吸衰竭是病死直接原因。消化道气管瘘分吻合口瘘和胃坏死穿孔两型,其中吻合口瘘型发生在术后6～33(平均19)d,胃坏死穿孔型发生在术后6～61(平均13)d。结合临床症状、消化道造影、食管镜和气管镜、手术探查等手段进行诊断。治疗手段包括手术修补3例,支架及手术联合支架植入8例,保守治疗3例。结论:消化道气管瘘是食管癌术后少见却严重危及生命的并发症。一旦发现,需即刻治疗,可根据病情的严重程度选择恰当的治疗方式。早期发现隐匿性消化道瘘并及时干预可有效预防本病的发生。Objective：To investigate the diagnosis,treatment and prognosis of gastrointestinal-tracheobronchial fistula after esophagectomy for esophageal cancer.Methods：A total of 1603 patients who underwent esophagectomy for esophageal cancer between 2008 and 2012 were analyzed retrospectively.Among them,14 cases were suffered from gastrointestinal-tracheobronchial fistula.The clinical manifestation,diagnosis,therapy and prognosis were analyzed.Results： The morbidity of gastrointestinal-tracheobronchial fistula was 0.87% and the mortality was 42.86%.Gastrointestinal-tracheobronchial fistula was classified as anastomotic leakage（n=9） and gastric necrosis and gastrobrosis（n=5）.The anastomotic leakage type appeared at postoperative day（POD） 6–33（average 19） after esophagectomy.The gastric necrosis type appeared at POD 6–61（average 13） after esophagectomy.The treatment options included operation（3 cases）,implantation of stent（6 cases）,operation combined with implantation of stent（2 cases）,and conservative treatment（3 cases）.Conclusions： Gastrointestinal-tracheobronchial fistula is a rare but life-threatening complication specifically observed after esophagectomy.Early diagnosis of intestinogastric fistula may prevent its progression.

关 键 词：食管癌 食管癌手术 消化道气管瘘 治疗 

分 类 号：R735.1[医药卫生—肿瘤]