化疗后气管/支气管-纵隔瘘一例并文献分析  

A case report of post-chemotherapy tracheal/bronchial-mediastinal fistula and literature review

作　　者：劳妙婵 高兴林 郭纪全 陈娉娉 崔景华 高平 Lao Miaochan;Gao Xinglin;Guo Jiquan;Chen Pinpin;Cui Jinghua;Gao Ping(Pulmonaryand Critical Care Medicine Department,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangdong Provincial Institute of Geriatrics,Guangzhou 510080,China)

机构地区：[1]广东省人民医院,广东省医学科学院,广东省老年医学研究所呼吸与危重症医学科,广州510080

出　　处：《国际呼吸杂志》2021年第2期149-153,共5页International Journal of Respiration

摘　　要：肿瘤和肿瘤治疗相关的呼吸道瘘比较罕见,对病情的预后产生重大的影响。本文通过分析1例弥漫大B细胞淋巴瘤患者化疗后出现多发气管/支气管-纵隔瘘的临床资料及诊治过程。检索中英文数据库,对肿瘤和肿瘤治疗相关的呼吸道瘘情况进行分析总结。本病例为76岁男性,呼吸困难20余天,CT提示:纵隔多发淋巴结肿大,气管、右侧主支气管受压狭窄,双肺多发结节,脾巨大占位性病变。右锁骨上淋巴结活检确诊弥漫大B细胞淋巴瘤,使用甲强龙及1个疗程环磷酰胺联合阿霉素化疗后,复查胸部CT及气管镜,发现多发气管/支气管-纵隔瘘。患者放弃进一步治疗,并于出院后2个月死亡。可继发呼吸道瘘的肿瘤相关治疗方式主要包括手术、化疗、靶向治疗及化疗或靶向治疗联合放疗。大部分通过消解肿瘤组织引起相邻器官之间的瘘道,而贝伐珠单抗更多的是通过引起食管炎、食管狭窄、食管糜烂等,最终导致气管食管瘘。新发的呼吸道瘘往往合并肿瘤进展,患者预后极差。在治疗前评估患者治疗相关呼吸道瘘发生的概率,对方案选择及患者的预后具有重要意义。Tumor and tumor management related respiratory fistula are rare,and cause bad prognosis.This study report the clinical progression of a case of post-chemotherapy tracheal/bronchial-mediastinal fistula.Database both in English and Chinese was searched.Tumor and tumor treatment related respiratory fistulas were concluded.This was a 76-year-old man,who complained of dyspnea for 20 days.A CT scan showed multiple enlarged lymph nodes in the mediastinum,multiple pulmonary and spleen masses,with the trachea and the right major bronchus compression and stenosis.A biopsy of the right supraclavicular lymph node suggested diffuse large B cell lymphoma.Methylprednisolone and one cycle of chemotherapy with cyclophosphamide and adriamycin was prescribed.A chest CT scan and a bronchoscopy after the chemotherapy,revealed newly acquired multiple tracheal and bronchial-mediastinal fistulas.The patient refused advanced treatment and passed away 2 months later.Airway fistulas can be secondary to tumor treatments,such as surgery,chemotherapy,targeted therapy and the combination of radiation,targeted therapy and radiation.Most of tumor treatments reduce the tumor volume and causes abnormal connection between adjacent organs.Bevacizumab induces oesophagitis,esophageal stricture,esophageal erosion,and eventually tracheoesophageal fistulas.Most new acquired respiratory fistulas accompanied with tumor progressions.The prognosis was extremely bad in such kind of patients.To assess the risk of tumor treatment related respiratory fistulas is important for establishing therapeutic regimen and patient prognosis.

关 键 词：呼吸道瘘 淋巴瘤 化疗 

分 类 号：R730.53[医药卫生—肿瘤]