Turkyilmaz Atila, Aydin Yener, Eroglu Atilla, Bilen Yusuf, Karaoglanoglu Nurettin
Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey.
Surg Laparosc Endosc Percutan Tech. 2009 Oct;19(5):364-7. doi: 10.1097/SLE.0b013e3181ba796d.
Esophagorespiratory fistula (ERF) is a complication of an esophageal malignancy that has serious effects on the mortality of a patient, whose survival is limited to weeks. Sealing of fistula and recovery of swallowing has greater importance than treating underlying primary malignancy. In this study, we aimed to present our clinic experience in patients with ERF and to discuss the findings together with the literature.
Between January 2003 and December 2008, 326 patients with malignant esophageal disorder were admitted to our clinic, and ERF detected in 18 (5.5%) patients. There were 10 men and 8 women with a mean age of 54.7+/-11.9 years (range: 34 to 75 y). Metastases in the lung and liver were detected in 4 and 2 patients, respectively. Empyema was found in 3 of the ERF patients. Pneumonic infiltration was detected via radiologic evaluation in 7 (38.9%) of the 18 patients. Two patients did not accept any intervention. A feeding gastrostomy tube was placed in 2 other patients. Fluoroscopy-guided Ultraflex esophageal stent placement was applied to the remaining 14 patients. Eleven (78.6%) patients underwent stent placements during generalized anesthesia via rigid esophagoscopy, and the remaining 3 (21.4%)patients via flexible esophagoscopy with sedation.
One of the patients who did not accept intervention died after 2 weeks, and the other died 6 weeks after admission. One of the patients who received a feeding gastrostomy tube died 17 weeks after admission, and the other was still alive after a month, when this article was written. Closure of the ERF was seen in all 14 patients who underwent palliative covered self-expandable metallic stent placement in the esophagus. No complications occurred in the stent-placed patients either during or after the procedure. Dyspeptic complaints and pain were treated successfully with medical therapy in 6 and 5 patients, respectively. Symptoms of aspiration disappeared after stent placement. No reopened fistulae were observed during follow-up. Thirteen of the 14 stent-replaced patients died during follow-up. The mean survival rate for these 13 patients was 11.2 weeks (range: 1 to 49 wk). The mean length of hospital stay after stent placement in the 14 patients was 3.7 days (1 to 15 d).
Covered self-expandable metallic stent placement in malign ERF patients is a technically simple and safer method for fistula closure and seems to be the most effective method that is easily available.
食管气管瘘（ERF）是食管恶性肿瘤的一种并发症，对患者死亡率有严重影响，患者生存期仅数周。封堵瘘口和恢复吞咽功能比治疗潜在的原发性恶性肿瘤更为重要。在本研究中，我们旨在介绍我们在ERF患者中的临床经验，并结合文献讨论研究结果。
2003年1月至2008年12月期间，326例食管恶性疾病患者入住我院，其中18例（5.5%）检测出ERF。男性10例，女性8例，平均年龄54.7±11.9岁（范围：34至75岁）。分别有4例和2例患者检测出肺和肝转移。18例ERF患者中有3例发生脓胸。18例患者中有7例（38.9%）通过影像学评估发现肺部浸润。2例患者未接受任何干预。另外2例患者放置了胃造瘘饲管。其余14例患者接受了透视引导下的Ultraflex食管支架置入术。11例（78.6%）患者在全身麻醉下通过硬式食管镜进行支架置入，其余3例（21.4%）患者在镇静下通过软式食管镜进行支架置入。
未接受干预的2例患者中，1例在2周后死亡，另1例在入院6周后死亡。接受胃造瘘饲管的2例患者中，1例在入院17周后死亡，另1例在撰写本文时入院1个月后仍存活。接受食管姑息性覆膜自膨式金属支架置入术的14例患者中，ERF均闭合。支架置入患者在手术期间及术后均未发生并发症。6例和5例患者分别通过药物治疗成功缓解了消化不良症状和疼痛。支架置入后误吸症状消失。随访期间未观察到瘘口重新开放。14例接受支架置换的患者中有13例在随访期间死亡。这13例患者的平均生存期为11.2周（范围：1至49周）。14例患者支架置入后的平均住院时间为3.7天（1至15天）。
在恶性ERF患者中置入覆膜自膨式金属支架是一种技术简单、更安全的瘘口封堵方法，似乎是最容易获得的最有效方法。
