Macke Ryan A, Foxwell Tyler, Luketich James D, Nason Katie S
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2015 Feb;99(2):e31-5. doi: 10.1016/j.athoracsur.2014.11.016.
Development of a tracheopharyngeal fistula after pharyngeal perforation is an uncommon occurrence. As a result, published guidance for management of this rare type of aerodigestive tract fistula is limited. We describe the workup and management of a traumatic tracheopharyngeal fistula caused by foreign body impaction. A conservative, endoscopic treatment strategy with broad-spectrum antibiotics, transnasal drainage, and covered tracheal stent placement was used. The stent was removed after 4 weeks, and complete closure of the fistula tract was confirmed by endoscopy and contrast esophagram. Although tracheopharyngeal fistulae are rare and operative treatment can be complex, this case demonstrates that conservative management with antibiotics, drainage, and endoscopic stenting can be successful in select patients.
咽穿孔后发生气管咽瘘并不常见。因此，针对这种罕见的气消化道瘘的已发表管理指南有限。我们描述了一例由异物嵌顿引起的创伤性气管咽瘘的检查和管理。采用了一种保守的内镜治疗策略，包括使用广谱抗生素、经鼻引流和放置带覆膜的气管支架。4周后取出支架，通过内镜检查和食管造影证实瘘道完全闭合。尽管气管咽瘘罕见且手术治疗可能复杂，但该病例表明，对于部分患者，采用抗生素、引流和内镜支架置入的保守治疗可能会取得成功。
