CAJ | 학술논문

目的总结食管癌切除、管状胃代食管术后并发胸胃-气管/支气管瘘的原因、诊断、预防及治疗经验.方法 2010年1月至2012年2月共应用管状胃代食管技术治疗食管癌手术切除食管癌1490例,发生胸胃-气管/支气管瘘10例,总发生率为0.67％,其中5例死亡.复习患者临床资料,总结分析瘘的发生原因、特点、治疗方法及预防措施.结果胸胃-气管/支气管瘘发生于左主支气管7例,气管远段2例,右支气管1例.首选内镜治疗8例,3例治愈,5例堵瘘失败者中2例死亡,3例行择期手术治疗,其中1例治愈,2例死亡；1例直接行手术治疗治愈；1例放弃治疗死亡.结论胸胃-气管/支气管瘘与手术操作损伤及管状胃切缘缝合材料磨损气管/支气管壁等因素有关,而严密缝合及妥善包埋胃小弯切缘、用人工材料或大网膜隔开支气管将有效减少胸胃气管瘘的发生,食管支架在管状胃内完全封闭瘘口有困难仅适于瘘口距吻合口较近的患者,气管支架可改善生活质量但很难使瘘口愈合,手术是最有效彻底解决问题的方案,以同期修补重建为佳,但要严格掌握指征.
목적 총결식관암절제、관상위대식관술후병발흉위-기관/지기관루적원인、진단、예방급치료경험.방법 2010년1월지2012년2월공응용관상위대식관기술치료식관암수술절제식관암1490례,발생흉위-기관/지기관루10례,총발생솔위0.67％,기중5례사망.복습환자림상자료,총결분석루적발생원인、특점、치료방법급예방조시.결과 흉위-기관/지기관루발생우좌주지기관7례,기관원단2례,우지기관1례.수선내경치료8례,3례치유,5례도루실패자중2례사망,3례행택기수술치료,기중1례치유,2례사망；1례직접행수술치료치유；1례방기치료사망.결론 흉위-기관/지기관루여수술조작손상급관상위절연봉합재료마손기관/지기관벽등인소유관,이엄밀봉합급타선포매위소만절연、용인공재료혹대망막격개지기관장유효감소흉위기관루적발생,식관지가재관상위내완전봉폐루구유곤난부괄우루구거문합구교근적환자,기관지가가개선생활질량단흔난사루구유합,수술시최유효철저해결문제적방안,이동기수보중건위가,단요엄격장악지정.
Objective To summarize our results and experience in dealing with the postoperative intrathoracic gastro-air-way fistulae after esophagectomy for esophageal carcinoma.Methods From January 2010 through February 2012,1490 patients with esophageal carcinoma underwent esophagectomy in our department.The postoperative intrathoracic gastro-airway fistulae were documented in 10 patients,with a frequency of 0.67％.Five of them died.The possible etiology,clinical characters,treatment and prevention of this complication were reviewed.Results The location of the fistulate were 7 at left main bronchus,1 at right main bronchus,and 2 at distal trachea.After 2-3 weeks conservative treatment,1 patient underwent primary surgical repair and cured,1 refused any further intervention and sacrified,8 patients underwent endoscopic insertion of covered stent and only 3 healed.For the remaining 5 cases with failed stent therapy,2 died of severe aspiration and lung infection,3 had surgical repair,one of them successed and 2 died of aspiration and aortic rupture,respecively.Conclusion The development of intrathoracic gastro-airway fistulae was associated with the iatrogenic injuries and suturing material irritation of the gastric tube to the tracheal/bronchial wall.Therefore,a meticulous closure and wapping of gastroplasty and appropriate isolation using artifical patch or great omentum between airway and esophageal substitution could effectively reduce the fistulae.The stent therapy usually fails in treating this entity and surgical repair remains the final and ratical therapeutic option.Primary repaire is suggested and careful preoperative assessment is crucial.