恶性食管呼吸道瘘的外科治疗13例分析.docVIP

KKME---专业医学搜索引擎/ 恶性食管呼吸道瘘的外科治疗13例分析 　　作者：陈晓伟,陈记财,陈钢　　作者单位：广东广州，广东省中医院胸外科 　　【摘要】 目的 总结近年来临床收治的恶性食管呼吸道瘘病例，包括食管气管瘘(TEF)和食管支气管瘘(BEF)的临床处治体会。方法 总结自1996年8月至2008年2月收治的13例恶性食管呼吸道瘘病例。结果 13例中TEF 6例;BEF 7例，其中：右侧6例、左侧1例。术前均有饮水呛咳和不同程度的支气管、肺内感染。诊断经X线拍片：口服水溶性造影剂直立位拍片;内镜：纤维胃镜、纤支镜检查后获得确诊。治疗均采取手术治疗，分别为：(1)TEF或BEF旷置、颈部食管-胃或结肠吻合术;(2)食管癌+瘘+肺叶切除、颈部食管-胃吻合术。13例术后均可获得良好的近期康复。结论 对于临床发生的恶性食管呼吸道瘘，应积极争取手术治疗，及时的手术治疗是防治肺内严重感染，改善预后的有效方法。 　　【关键词】 恶性食管呼吸道瘘 外科 治疗 　　[Abstract] Objective To summarize the clinical therapeutic experience about malignant tracheoesophageal fistula(MTEF)recently.Methods We collected 13 cases of MTEF patients hospitalized in our department from Aug.1996 to Feb.2008 and summarized the clinical effectiveness of surgery treatment.Results All of 13 comprised 6 cases with tracheoesophageal fistula(TEF)and 7 cases with bronchoesophageal fistula(BEF)，in which 6 cases with fistula orifice locating on the right bronchus and 1 case on the left side.The typical symptom of MTEF presents coughing while drinking(Onos sign)and other symptoms including signs about infection of bronchus or lungs，such as fever，pneumonia，hemoptysis and chest-pain.It can be diagnosed by plain chest radiographs，erect position chest radiographs after taking oral water-soluble contrast material，bronchoscopy or esophagoscopy.Treatment options consist of:(1)esophageal exclusion and bypass with cervical esophagogastric or esophagocolonic anastomosis;(2)esophageal carcinoma，fistula and lobe resection with cervical esophagogastric anastomosis.Eventually，the whole patients were survived in the perioperative period.Conclusion MTEF is a serious complication with dismal prognosis.It should adopt active measures involving surgery as soon as it is diagnosed.Active，timely and proper surgery may improve the prognosis of MTEF. 　　[Key words] malignant tracheoesophageal fistula;surgery;treatment 　　本组收集自1996年8月至2005年2月共收治的13例恶性食管呼吸道瘘患者，就其恶性食管呼吸道瘘的外科诊治体会结合文献复习归纳报告如下。 　　1 资料与方法 　　1.1 一般资料 全组13例，均为男性，平均年龄(