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食管支架置入相关食管气管瘘、气管狭窄及气管破裂的处理:1例病例报告并文献复习

Management of esophageal stenting-associated esophagotracheal fistula, tracheal stenosis and tracheal rupture: a case report and review of the literature.

作者信息

Ji Fanceng, Nie Peihe, Yi Fuxia, Zhang Limin

机构信息

Department of Anesthesiology, Weifang People's Hospital Weifang 261041, China.

Department of anesthesiology, Affiliated Hospita of Weifang Medical University Weifang 261031, China.

出版信息

Int J Clin Exp Pathol. 2015 Aug 1;8(8):9332-6. eCollection 2015.

PMID:26464685
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4583917/
Abstract

OBJECTIVE

Although the placement of esophageal self-expandable stents (SES) can effectively relieve dysphagia after radiotherapy in patients with esophageal cancer (EC), it may induce severe esophageal complications. This article reports a case of emergency endotracheal intubation in an EC patient who suddenly developed severe dyspnea two months after SES placement.

METHODS

Electronic bronchoscopy of the patient's airway confirmed the diagnosis of esophagotracheal fistula, tracheal stenosis and tracheal rupture. Endotracheal intubation was successfully performed under the guidance of electronic bronchoscopy.

RESULTS

Dyspnea due to tracheal stenosis was relieved effectively by inserting the tracheal catheter to a proper place under the guidance of electronic bronchoscopy.

CONCLUSION

Bronchoscopic examination is strongly recommended in EC patients who are highly suspected as having airway stenosis associated with esophageal stenting, for which endotracheal intubation under the guidance of bronchoscopy is suggested.

摘要

目的

尽管放置食管自膨式支架(SES)可有效缓解食管癌(EC)患者放疗后的吞咽困难,但可能引发严重的食管并发症。本文报道1例EC患者在SES置入2个月后突然出现严重呼吸困难而行紧急气管插管的病例。

方法

对患者气道进行电子支气管镜检查,确诊为食管气管瘘、气管狭窄和气管破裂。在电子支气管镜引导下成功实施气管插管。

结果

在电子支气管镜引导下将气管导管插入合适位置,有效缓解了气管狭窄所致的呼吸困难。

结论

强烈建议对高度怀疑存在与食管支架置入相关气道狭窄的EC患者进行支气管镜检查,建议在支气管镜引导下进行气管插管。

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本文引用的文献

1
Stent-associated esophagorespiratory fistulas: incidence and risk factors.支架相关的食管-呼吸道瘘:发生率和危险因素。
Gastrointest Endosc. 2013 Feb;77(2):181-9. doi: 10.1016/j.gie.2012.10.004. Epub 2012 Dec 11.
2
Airway complications after covered stent placement for malignant esophageal stricture: special reference to radiation therapy.气道并发症在恶性食管狭窄覆膜支架置入后的发生:特别参考放射治疗。
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Stents for proximal esophageal cancer: a case-control study.支架治疗食管近端癌:一项病例对照研究。
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Combined airway and oesophageal stenting in malignant airway-oesophageal fistulas: a prospective study.联合气道和食管支架置入治疗恶性气道-食管瘘:一项前瞻性研究。
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Tracheal rupture after endotracheal intubation: a literature systematic review.气管插管后气管破裂:一项文献系统综述
Eur J Cardiothorac Surg. 2009 Jun;35(6):1056-62. doi: 10.1016/j.ejcts.2009.01.053. Epub 2009 Apr 14.
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Tracheal rupture in burns--a retrospective study.
Burns. 2008 Jun;34(4):525-30. doi: 10.1016/j.burns.2007.06.017. Epub 2007 Oct 24.
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Management of tracheobronchial ruptures in critically ill patients.危重症患者气管支气管破裂的管理
Minerva Anestesiol. 2007 Jul-Aug;73(7-8):443.
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9
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10
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Ann Otol Rhinol Laryngol. 2006 Jun;115(6):408-11. doi: 10.1177/000348940611500602.