Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Nat Rev Gastroenterol Hepatol. 2010 Dec;7(12):702-6. doi: 10.1038/nrgastro.2010.171. Epub 2010 Nov 9.
A 63-year-old woman presented with dysphagia owing to proximal esophageal stenosis 27 years after she received radiation therapy for Hodgkin disease. She had previously experienced various other complications of this treatment, including myelopathy, hypothyroidism, and cardiomyopathy.
Medical history and physical examination, pathology and immunohistochemistry, bronchoscopy, esophagogastroscopy, chest and abdominal PET-CT scan, examination of the thorax during open right thoracotomy.
Large tracheoesophageal fistula and poorly differentiated squamous cell carcinoma of the esophagus.
The stenosis was treated with endoscopic dilatations and brachytherapy, but persisted and became a tracheoesophageal fistula despite repeated placement of esophageal stents. Definitive surgical treatment comprised combined transabdominal and thoracic esophagectomy with creation of a gastric tube and cervical esophagogastrostomy, and repair of the trachea with a pericardial patch and intercostal muscle flap.
一位 63 岁女性因霍奇金病接受放射治疗 27 年后出现食管近端狭窄导致吞咽困难。她此前经历了这种治疗的多种其他并发症，包括脊髓病、甲状腺功能减退症和心肌病。
病史和体格检查、病理学和免疫组织化学、支气管镜检查、食管胃十二指肠镜检查、胸部和腹部 PET-CT 扫描、开胸右开胸时胸部检查。
大气管食管瘘和食管低分化鳞状细胞癌。
采用内镜扩张和近距离放射治疗狭窄，但尽管反复放置食管支架，狭窄仍持续存在并发展为气管食管瘘。确定性手术治疗包括经腹和经胸联合食管切除术，创建胃管和颈食管胃吻合术，并使用心包补片和肋间肌瓣修复气管。
