Li Jing, Gao Xinglin, Chen Jingjing, Lao Miaochan, Wang Shushui, Zeng Guohong
Respiratory Department, Guangdong Geriatrics Institute and Guangdong General Hospital, Guangdong, 510080, China.
Respiratory Department, Guangdong Academy of Medical Sciences and Guangdong General Hospital, Guangdong, 510080, China.
Respir Med. 2015 Aug;109(8):1069-78. doi: 10.1016/j.rmed.2015.04.014. Epub 2015 May 5.
To report an endoscopic treatment for inoperable oesophagorespiratory fistulas (ORFs).
Six patients with inoperable acquired tracheobronchial-oesophageal fistulas (four males and two females; mean age, 70.2 ± 10.28 years) were included. Cardiac septal defect occluders or vascular plugs were implanted through a flexible bronchoscope to close the ORFs. Monthly follow-ups were done for 16 months.
All fistulas were successfully closed immediately after the procedure. The severe aspirated pneumonia was controlled in 7-10 days. The two mechanically ventilated patients were weaned successfully from the ventilator, and the general condition of patients improved rapidly. However, the fistulas recanalised in four patients because of the cutting effect of the edge of the occluders 1-12 months after the procedure. Other reasons, such as compression of the tracheal intubation balloon and repeated inflammation of the oesophageal diverticulum, may also have contributed to the recanalisation.
Endoscopic closure of acquired ORFs with cardiac septal defect occluders or vascular plugs improve patients' general condition immediately after the procedure, but may result in recanalisation longterm. The occlusion might be considered an abridgement to surgery.
报告一种针对无法手术的食管气管瘘（ORF）的内镜治疗方法。
纳入6例无法手术的后天性气管支气管-食管瘘患者（4例男性，2例女性；平均年龄70.2±10.28岁）。通过可弯曲支气管镜植入心脏间隔缺损封堵器或血管栓塞以封闭ORF。进行了为期16个月的每月随访。
术后所有瘘口均立即成功封闭。严重吸入性肺炎在7 - 10天内得到控制。2例机械通气患者成功脱机，患者的一般状况迅速改善。然而，4例患者的瘘口在术后1 - 12个月因封堵器边缘的切割作用而重新贯通。其他原因，如气管插管气囊的压迫和食管憩室的反复炎症，也可能导致了重新贯通。
用心脏间隔缺损封堵器或血管栓塞进行内镜下封闭后天性ORF可在术后立即改善患者的一般状况，但长期可能导致重新贯通。这种封堵可被视为手术的一种替代方法。
