成人食管-肺瘘临床分析  

Clinical analysis of adult Esophago-pulmonary fistula

作　　者：王骞 全玲丽 罗细萍 谭林 屈伟明 周红兵[1] 陈维顺[1] WANG Qian;QUAN Ling-li;LUO Xi-ping;TAN Lin;QU Wei-ming;ZHOU Hong-bing;CHEN Wei-shun(Department of Gastroenterology,The Affiliated Zhuzhou Hospital Xiangya Medical College CSU,Zhuzhou 412007,China;Department of Respiratory and Critical Care Medicine,The Affiliated Zhuzhou Hospital Xiangya Medical College CSU,Zhuzhou 412007,China)

机构地区：[1]中南大学湘雅医学院附属株洲医院消化内科,412007 [2]中南大学湘雅医学院附属株洲医院呼吸与危重症医学科,412007

出　　处：《现代消化及介入诊疗》2020年第6期711-716,723,共7页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：湖南省自然科学基金(2017JJ4071,2018JJ3895,2019JJ60085)。

摘　　要：目的总结成人食管-肺瘘(esophago-pulmonary fistula,EPF)的临床特点与诊疗手段,提高临床医师对EPF的认识。方法对中南大学湘雅医学院附属株洲医院收治的1例及国内外文献报道的33例成人EPF患者的临床资料进行综合分析。结果34例EPF患者,男女比例1.6∶1.0,年龄17~72岁,中位年龄53岁。临床表现主要有咳嗽、咳脓痰,而进食后呛咳较少见(6/34)。CT瘘管发现率为50.0%(10/20)。上消化道钡餐与胃镜检查阳性率高,分别达93.7%、82.4%。食管瘘口位于食管上、中、下段分别为4例(14.8%)、12例(44.4%)、11例(40.8%),左侧肺瘘11例(33.3%)、右侧22例(66.7%)。食管癌是主要病因,良性EPF则多见于贲门失弛缓症。5例进行内镜下治疗,3人死亡,19例手术治疗,3人死亡。恶性EPF死亡率(71.4%)明显高于良性者(33.3%)。结论成人EPF是一种临床罕见疾病,临床表现缺乏特异性,容易误诊为支气管扩张、肺脓肿等疾病,钡餐造影及胃镜检查可协助诊断。大多数患者需手术治疗,内镜下治疗可作为早期良性EPF及晚期恶性EPF姑息性治疗选择,恶性EPF患者预后不良。Objective To summarize the characteristics,diagnosis and treatment methods of adult esophago-pulmonary fistula(EPF)and improve the clinicians′understanding of this disease.Methods Analyzing the clinical data of 1 case of adult EPF in our hospital and 33 cases reported in literature.Results Male/female ratio was 1.6∶1.0,age from 17-72 years old,the median age was 53 years.Coughing and expectorating purulent sputum were the main clinical manifestations,however,choking and coughing after consuming was rare(6 cases).The incidence of fistula was found by CT in 50%(10 cases).The positive rates of barium radiography of upper digestive tract and gastroscopy were 93.7%and 82.4%,respectively.The fistula was located in the upper,middle and lower esophagus in 4 cases(14.8%),12 cases(44.4%)and 11 cases(40.8%),respectively,left pulmonary fistula in 11 cases(33.3%),and right pulmonary fistula in 22 cases(66.7%).The main cause was esophageal cancer,while benign esophageal-pulmonary fistula was more common in achalasia.5 cases were treated by endoscope,3 cases died,19 cases underwent operation and 3 cases died.The mortality of malignant esophageal-pulmonary fistula(71.4%)was significantly higher than that of benign esophagus-lung fistula(33.3%).Conclusion Adult esophageal-pulmonary fistula is a rare disease,which is easy to be misdiagnosed as bronchiectasis or pulmonary abscess due to lack of specificity in clinical manifestations.Barium radiography and gastroscopy can assist in the diagnosis.Most patients need surgery treatment.Endoscopic treatment can be used for early benign EPF and advanced malignant EPF as palliative treatment.And the prognosis of malignant EPF patients is poor.

关 键 词：食管-肺瘘 临床特点 诊断 治疗 

分 类 号：R562.13[医药卫生—呼吸系统] R571[医药卫生—内科学]