Mathisen D J, Grillo H C, Wain J C, Hilgenberg A D
Department of Surgery, Massachusetts General Hospital, Boston 02114.
Ann Thorac Surg. 1991 Oct;52(4):759-65. doi: 10.1016/0003-4975(91)91207-c.
Acquired, nonmalignant tracheoesophageal fistula is an uncommon and difficult problem to manage. The most common cause is a complication of endotracheal or tracheostomy tubes. Most are diagnosed while patients still require mechanical ventilation. We use a conservative approach until patients are weaned from ventilation. A tracheostomy tube is placed so that the balloon rests below the fistula, if possible, to prevent contamination of the tracheobronchial tree. A gastrostomy tube is placed for drainage and a separate jejunostomy tube for nutrition. Single-stage repair is done after the patient is weaned from mechanical ventilation. Esophageal diversion is rarely required. We have performed 41 operations on 38 patients. Simple division and closure of the fistula was done in 9 patients and tracheal resection and reconstruction in the remainder. The esophageal defect was closed in two layers and a viable strap muscle interposed between the two suture lines. There were four deaths (10.9%). There were three recurrent fistulas and one delayed tracheal stenosis. All were successfully managed. Of the 34 surviving patients, 33 aliment themselves orally and 32 breathe without the need for a tracheal appliance.
获得性非恶性气管食管瘘是一种少见且难以处理的问题。最常见的病因是气管内插管或气管造口管的并发症。大多数在患者仍需要机械通气时被诊断出来。在患者脱机之前，我们采用保守治疗方法。如果可能，放置气管造口管，使气囊位于瘘口下方，以防止气管支气管树受到污染。放置胃造瘘管用于引流，另放置空肠造瘘管用于营养支持。患者脱机后进行一期修复。很少需要行食管转流术。我们对38例患者实施了41次手术。9例患者行瘘口单纯分离闭合术，其余患者行气管切除重建术。食管缺损分两层缝合，在两条缝线之间置入一条存活的带状肌。有4例死亡（10.9%）。有3例复发性瘘和1例迟发性气管狭窄。所有这些情况均成功处理。在34例存活患者中，33例经口进食，32例无需气管造口装置即可呼吸。
