不同方法治疗获得性气管、支气管食管瘘的临床特点和疗效的研究  

Study on the clinical characteristics and efficacy of different methods in the treatment of acquired tracheal-bronchoesophageal fistula

作　　者：陈云[1] 李旭[1] 王平[1] 王家平[1] 向述天[2] 曾俊仁[2] 凌锋[1] 刘鑫[1] 罗娜 杨绍军[1] CHEN Yun;LI Xu;WANG Ping;WANG Jiaping;XAIANG Shutian;ZENG Junren;LING Feng;LIU Xin;LUO Na;YANG Shaojun(Department of Thoracic Surgery,the Second Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650101,China;Department of Radiological Interventional Therapy,Yunnan Second People′s Hospital,Kunming,Yunnan 650021,China)

机构地区：[1]昆明医科大学第二附属医院胸外科,昆明650101 [2]云南省第二人民医院放射介入科,昆明650021

出　　处：《重庆医学》2020年第8期1302-1306,共5页Chongqing medicine

摘　　要：目的探讨不同方法治疗获得性气管、支气管食管瘘(ATEF)的临床特点和疗效,总结不同治疗方法的选择适应证。方法回顾性分析36例ATEF患者的临床资料,根据不同治疗方法分为三组,即外科手术组8例、介入治疗组25例和保守治疗组3例,观察不同治疗组成功率、有效率、生存期和主要并发症等。结果外科手术组采用4种手术方式进行治疗,手术均获得成功,1例术后食管胸膜瘘,2例肺部感染,经保守治疗后恢复,其余5例均无术后重大并发症,随访1月-8年,3例因食管癌肿瘤复发而死亡,其余5例均生存至今。介入治疗组在支气管镜和数字减影血管造影(DSA)辅助下行气道、食道或气道食道支架植入术,术后患者生活质量明显改善,随访1个月至4年,出现支架移位或封堵不佳5例,气道内新生物6例,致死性大咯血或呕血5例,介入治疗组中恶性病因患者在0.3~5个月内死亡,非恶性病因患者均生存至今,但患者反复入院行多次介入治疗。保守治疗患者3例均在0.6~1个月内死亡。结论外科手术和介入治疗在ATEF治疗中安全有效;良性ATEF首选外科手术,恶性ATEF首选介入治疗,保守治疗疗效最差。Objective To investigate the clinical characteristics and efficacy of different methods in treating acquired tracheo-bronchoesophageal fistula(ATEF),and to summarize the indications for selecting the different treatment methods.Methods The clinical data of 36 patients with ATEF were retrospectively analyzed.According to different treatment methods,the patients were divided into three groups,namely 8 cases in the surgical group,25 cases in the interventional treatment group and 3 cases in the conservative treatment group.The success rate,effective rate,survival period and main complications were observed in different groups.Results In the surgical group,4 surgical methods were used for treatment,and all surgeries were successful.One case of postoperative esophageal pleural fistula and 2 cases of pulmonary infection recovered after conservative treatment,and the remaining 5 cases all had no major postoperative complications.The follow-up period lasted from 1 month to 8 years,3 cases died due to esophageal cancer recurrence,and the remaining 5 cases survived till now.The intervention group under the bronchoscope and DSA aided airway,esophagus or airway esophageal stent implantation,the patient′s postoperative quality of life was improved significantly,and the follow-up lasted from 1 month to 4 years,the stent migration or poor sealing appeared in 5 cases,6 cases had the airway granulation tissue,and 5 cases had fatal severe hemoptysis or hematemesis;in the interventional treatment group,the patients with malignant etiology died within 0.3-5 months,and the patients with non-malignant etiology suvived until now,but the patients conducted the repeated hospitalization to perform the interventional therapy for many times.All 3 cases of conservative treatment died within 0.6-1 month.Conclusion Surgery and interventional therapy are safe and effective in ATEF.Surgery is the first choice for benign ATEF,the interventional treatment is the first choice for malignant ATEF,and the conservative treatment has the worst effect.

关 键 词：获得性气管、支气管食管瘘 外科手术 介入治疗 保守治疗 

分 类 号：R562[医药卫生—呼吸系统]