MacIntosh E L, Parrott J C, Unruh H W
Department of Surgery, University of Manitoba, Winnipeg, Canada.
Ann Thorac Surg. 1991 Mar;51(3):515-9. doi: 10.1016/0003-4975(91)90888-w.
Aortobronchial fistula is a rare condition that is invariably fatal if not diagnosed and surgically treated. With appropriate surgical intervention, survival rates greater than 70% can be achieved. A review of the literature and an illustrative case report are presented. A total of 63 fistulas in 62 patients have been described. The case we present is unusual in the use of serratus anterior muscle for repair of the fistula. Eighty-seven percent of the cases documented in the literature were associated with an aneurysm of the thoracic aorta. Eighty-six percent of the fistulas were between the descending aorta and left bronchopulmonary tree. More than 95% of patients experienced at least a single episode of hemoptysis, and massive hemoptysis occurred in more than half of the reported cases. A correct preoperative diagnosis was made in only 54% of cases. Plain chest radiographs definitively demonstrated an aneurysm in only 16%. The computed tomographic scan was the most rewarding test, identifying an aneurysm in 11 of 12 patients and the fistula in 50% of them. Surgical repair resulted in a 76% survival rate.
主动脉支气管瘘是一种罕见的疾病，如果不进行诊断和手术治疗，必然会导致死亡。通过适当的手术干预，生存率可超过70%。本文对相关文献进行了综述，并报告了一个典型病例。文献中共描述了62例患者的63处瘘管。我们所呈现的病例在使用前锯肌修复瘘管方面较为特殊。文献记载的病例中，87%与胸主动脉瘤有关。86%的瘘管位于降主动脉与左支气管肺树之间。超过95%的患者至少经历过一次咯血，超过半数的报告病例出现过大量咯血。仅54%的病例在术前得到了正确诊断。胸部X线平片仅在16%的病例中明确显示出动脉瘤。计算机断层扫描是最有价值的检查，在12例患者中的11例发现了动脉瘤，其中50%发现了瘘管。手术修复后的生存率为76%。
