Sokolov V V, Bagirov M M
Kiev Clinical Hospital No. 17, Kiev, Ukraine.
Eur J Cardiothorac Surg. 2001 Nov;20(5):1025-9. doi: 10.1016/s1010-7940(01)00953-8.
To evaluate surgical options of treatment in combined tracheo-esophageal injuries and their sequelae and elaborate new ones.
The overlooked diagnosis of combined tracheo-esophageal injury would lead to severe stenosis of the esophagus and trachea with tracheo-esophageal fistula. This condition requires a complex surgical intervention to be performed with non-standard procedure in every single case. Forty patients with combined tracheo-esophageal injuries were treated in our institution. Nine patients were urgently operated while others were transferred to us from other hospitals with chronic sequelae of the initial trauma.
In the majority of cases the cause of the injury was penetrating (17 patients) or iatrogenic (13 patients) trauma followed by blunt neck and chest trauma (six patients) and caustic burn (four patients). Three patients had total cut off of the esophagus and trachea, which were repaired with end-to-end anastomoses. Another six patients had tracheal and esophageal disruptions within one-half to three-quarters of circumference. In these cases both the trachea and esophagus were mobilized within wall laceration and sutured by interrupted Vicryl 4/0. One of them died due to pre-existing disease. Thirty-one patients with sequelae of the trauma were also operated on. In spite of the complexity and extent of the tracheo-esophageal stenosis and fistula the surgical treatment was aimed to one-stage reconstruction of both the esophagus and trachea. For this purpose we performed an originally developed surgical intervention, which was to be modified in accordance with patients diagnosis. The main point of the procedure is that after mobilization of the trachea and esophagus we resect an involved part of the trachea, but preserve a pedicled flap fashioned from the tracheal membrane. Then we remove the mucosa from the flap, resect an involved esophageal wall, repair esophageal mucosa and replace the defect of the muscular layer of the esophagus with the tracheal flap. Then a tracheal or laryngo-tracheal anastomosis is established. There were no postoperative mortality and complications among patients with the sequelae.
Combined tracheo-esophageal injury requires the precise preoperative diagnosis and well organized plan of surgical treatment, which may be unique for every single patient. The main purpose of the treatment is to restore the continuity of both the esophagus and trachea in one-stage intervention.
评估气管食管联合损伤及其后遗症的手术治疗方案，并阐述新的治疗方案。
气管食管联合损伤若漏诊会导致食管和气管严重狭窄并伴有气管食管瘘。这种情况需要针对每个病例采用非标准手术程序进行复杂的手术干预。我院收治了40例气管食管联合损伤患者。9例患者接受了急诊手术，其他患者则是因初始创伤的慢性后遗症从其他医院转至我院。
在大多数病例中，损伤原因是穿透性创伤（17例）或医源性创伤（13例），其次是钝性颈部和胸部创伤（6例）以及腐蚀性烧伤（4例）。3例患者的食管和气管完全离断，采用端端吻合进行修复。另外6例患者的气管和食管破裂范围在圆周的二分之一至四分之三。在这些病例中，气管和食管均在壁内撕裂处游离并间断用4/0薇乔缝线缝合。其中1例因原有疾病死亡。31例有创伤后遗症的患者也接受了手术。尽管气管食管狭窄和瘘的情况复杂且范围广泛，但手术治疗旨在一期重建食管和气管。为此我们实施了一项原创的手术干预措施，并根据患者诊断进行调整。该手术的要点是在游离气管和食管后，切除气管的受累部分，但保留由气管膜形成的带蒂皮瓣。然后从皮瓣上去除黏膜，切除受累的食管壁，修复食管黏膜，并用气管皮瓣替代食管肌层的缺损。接着进行气管或喉气管吻合。有后遗症的患者术后无死亡病例和并发症。
气管食管联合损伤需要精确的术前诊断和精心组织的手术治疗方案，每个患者的方案可能都不相同。治疗的主要目的是在一期干预中恢复食管和气管的连续性。
