食管狭窄支架植入后发生气管食管瘘的外科治疗  

Surgical treatment of tracheoesophageal fistula after stent implantation for esophageal stenosis

作　　者：刘高利[1] 王新[2] 宋恒雅 张文涵 杨森 龙杏林 黄杰[1] 谢颂平[1] LIU Gaoli;WANG Xin;SONG Hengya;ZHANG Wenhan;YANG Sen;LONG Xinglin;HUANG Jie;XIE Songping(Dept.of Thoracic Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Thoracic Surgery,Nanyang Central Hospital,Nanyang 473005,Henan,China)

机构地区：[1]武汉大学人民医院胸外科,湖北武汉430060 [2]南阳市中心医院胸外科,河南南阳473005

出　　处：《武汉大学学报（医学版）》2023年第7期859-862,共4页Medical Journal of Wuhan University

摘　　要：目的:探讨结肠代食管手术在食管狭窄支架植入后发生气管食管瘘患者中的应用效果。方法:回顾性分析武汉大学人民医院胸外科2015年4月到2019年7月治疗的7例继发性食管狭窄放置支架后出现气管食管瘘患者的临床资料,总结结肠代食管术在该类患者中的应用经验。结果:全组患者无围手术期死亡发生。一期手术4例,分期手术3例。行结肠代食管7例(胸骨后隧道6例,胸部皮下隧道1例)。术后发生肺部感染2例,心律失常1例,均经保守治疗后痊愈。术后随访半年至1年,无气管食管瘘复发。患者均能正常进食,体重较术前增加3~10kg。结论:采用结肠代食管手术治疗继发性食管狭窄置入支架导致的气管食管瘘效果良好,该术式为类似患者的治疗提供了一种新的选择。Objective:To explore the effect of esophageal replacement by colonic interposition in patients with tracheoesophageal fistula after stent implantation for esophageal stenosis.Methods:The clinical data of 7 patients with tracheoesophageal fistula after stent implantation for esophageal stenosis in the Department of Thoracic Surgery,Renmin Hospital of Wuhan University from April 2015 to July 2019 were retrospectively analyzed,and the application experience of colonic interposition for esophageal re⁃placement in such patients was summarized.Results:No perioperative death was found,four cases underwent one stage operation,and 3 cases underwent two stage operation.Colon replacement of esophagus was performed in 7 cases(retrosternal tunnel in 6 cases and subcutaneous tunnel in 1 case).Postoperative pulmonary infection occurred in 2 cases,and acute left heart failure occurred in 1 case due to pleural effusion with pleural puncture and drainage.All cases recovered after conservative treatment.The patients were followed up ranged from six months to one year,and there was no recur⁃rence of tracheal esophageal fistula.Conclusion:The operation of colonic interposition for esophageal substitution in the treatment of tracheoesophageal fistula caused by stent placement in secondary esophageal stenosis has a good effect,and this operation provides a new option for the treatment of similar patients.

关 键 词：气管食管瘘 食管支架 食管狭窄 结肠代食管术 

分 类 号：R562.13[医药卫生—呼吸系统] R571.1[医药卫生—内科学]