Nardella Jane E, Van Raemdonck Dirk, Piessevaux Hubert, Deprez Pierre, Droissart Raphaël, Staudt Jean-Pierre, Heuker David, van Vyve Etienne
Department of Surgery, St Jean Hospital, Brussels, Belgium.
J Cardiothorac Surg. 2009 Nov 29;4:69. doi: 10.1186/1749-8090-4-69.
A gastro-tracheal fistula following esophagectomy for cancer is a rare but potentially lethal complication. We report the successful surgical closure after failed endoscopic treatment, of a gastro-tracheal fistula following esophago-gastrectomy for cancer after induction chemo-radiotherapy.
A 58 year-old male patient presented with a distal third uT3N1 carcinoma of the esophagus. After induction chemo-radiotherapy, he underwent an esophago-gastrectomy with radical lymphadenectomy and reconstruction by gastric pull-up. Immediate postoperative outcome was uneventful. On the 15th postoperative day however, our patient was readmitted in the Intensive Care Unit with severe bilateral basal pneumonia. Three days later a gastro-tracheal fistula was diagnosed upon gastroscopy and bronchoscopy. His good general condition allowed for an endoscopic primary approach which consisted in the insertion of a covered stent in the trachea along with clipping and glueing of the gastric fistular orifice. Two attempts proved unsuccessful.
After several weeks of conservative measures, surgical re-intervention through a right thoracotomy with transection of the fistula and closure by primary interrupted sutures of both fistular orifices along with intercostal muscle flap interposition led to excellent patient outcome. Oral feeding was started and our patient was discharged.
食管癌切除术后发生胃气管瘘是一种罕见但可能致命的并发症。我们报告了一例在诱导放化疗后行食管癌胃切除术治疗癌症后发生胃气管瘘，经内镜治疗失败后成功进行手术闭合的病例。
一名58岁男性患者，患有食管远端三分之一处的uT3N1期癌。诱导放化疗后，他接受了食管癌胃切除术，行根治性淋巴结清扫，并通过胃上提术进行重建。术后即刻恢复顺利。然而，术后第15天，患者因严重双侧基底肺炎被收入重症监护病房。三天后，经胃镜和支气管镜检查诊断为胃气管瘘。患者一般状况良好，可行内镜下的初步治疗，即在气管内插入覆膜支架，并对胃瘘口进行夹闭和粘贴。两次尝试均未成功。
经过数周的保守治疗后，通过右胸切开术进行手术再次干预，切断瘘管，对两个瘘口进行一期间断缝合，并置入肋间肌瓣，患者取得了良好的治疗效果。开始经口进食，患者出院。
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