主动脉疾病相关不同类型主动脉食管瘘临床特点的病例系列研究  

Clinical characteristics in patients with aortoesophageal fistula related to aortic lesions

作　　者：李珊[1] 高峰[1] 胡海瓯[2] 石进[1] 张杰[1] LI Shan;GAO Feng;HU Haiou;SHI Jin;ZHANG Jie(Department of Gastroenterology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院消化内科,100029 [2]首都医科大学附属北京安贞医院主动脉外科二病区

出　　处：《心肺血管病杂志》2021年第12期1226-1229,1238,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:本研究对主动脉瘤及主动脉夹层相关原发性和继发性主动脉食管瘘(AEF)的临床表现、诊断、治疗及预后的不同特点进行研究。方法:检索2000年1月1日至2020年11月28日,PubMed、Embase和Cochrane以及万方、维普数据库,根据病因分为原发性和继发性AEF并进行比较。结果:共纳入275例主动脉疾病相关AEF患者,平均年龄(65.1±13.9)岁,65.6%为男性。其中原发性AEF共119例,继发性AEF共156例。与原发性AEF相比,继发性AEF出现消化道出血、失血性休克、吞咽困难以及Chiari三联征明显较少(P<0.001;P<0.001;P=0.007;P=0.005),发热、炎症指标升高更常见(P<0.001),差异均有统计学意义。CT示主动脉造影剂外溢、纵膈内食管/动脉瘤周围气体影有确诊价值,可作为首选;内镜下经食管壁瘘口见到管壁外组织以及搏动性动脉出血也有确诊价值。Kaplan-Meier生存分析显示AEF患者1年累积生存率为(40.4±3.4)%,最常见的死亡原因是出血(55.2%)和脓毒血症(29.4%)。结论:原发性和继发性AEF临床表现存在一定差异,继发性AEF患者发热、炎症指标升高等感染相关表现更常见,吞咽困难、消化道出血比例较低。对此类患者需提高警惕,避免延误诊断及治疗。Objective:We systematically reviewed the literature of the aortoesophageal fistula(AEF)cases related to aortic aneurysm or dissection and assessed the differences of clinical characteristics,diagnostic methods,treatments and prognosis between primary and secondary AEF.Methods:A systematic search was undertaken in the PubMed,Embase,Cochrane Library,Wanfang and CQVIP databases from 2000 to November 28,2020.All cases were divided into primary and secondary AEF groups,and then the clinical characteristics were analyzed.Results:The systematic review included 275 patients with AEF.The mean age was 65.1±13.9 years,and 65.6%of patients were men.There were 119 cases of primary AEF and 156 cases of secondary AEF.Secondary AEF patients presented with less gastrointestinal bleeding,hemorrhagic shock,dysphagia and the Chiari triad while more infection-related symptoms(P<0.001;P<0.001;P=0.007;P=0.005;P<0.001),compared with primary AEF patients.The most specific signs of AEF in computed tomography(CT)were extravasated contrast material and air bubbles around the thoracic aorta,while pulsatile arterial hemorrhage and visible graft or other foreign body were also specific endoscopic manifestations.Kaplan-Meier survival analysis showed that the 1-year cumulative survival rate was(40.4±3.4)%.The most common causes of death were bleeding(55.2%)and infection(29.4%).Conclusions:Secondary AEF patients presented with less gastrointestinal bleeding,hemorrhagic shock and dysphagia while more infection-related symptoms compared with primary AEF patients.It is necessary to be vigilant for these patients to avoid delay in diagnosis and treatment.

关 键 词：主动脉食管瘘 消化道出血 主动脉瘤 主动脉夹层 

分 类 号：R54[医药卫生—心血管疾病]