Couraud L, Bercovici D, Zanotti L, Clerc P, Velly J F, Dubrez J
Ann Chir. 1989;43(8):677-81.
Oesophago-tracheal fistulae secondary to respiratory intensive care have become the commonest type of non-tumoural fistula in adults: 17/26 cases. They complicated a long period of difficult and septic intensive care, after a mean interval of 30 days. The diagnosis was confirmed by bronchoscopy which also provided good assessment of the site and extent of the fistula and the associated tracheal lesions. The severity of this complication is stressed by 5 deaths in the present series (1 toxi-infectious syndrome after 24 hours, 2 abandonments due to a hopeless resuscitation prognosis, 2 cases of oesophago-tracheal reflux which could have been prevented). One should not wait for spontaneous cure (although this did take place in 2 cases). Ideal direct suture (9 cases: 9 cures) requires local conditions favourable for healing and rapid respiratory autonomy. These conditions can be achieved by an active approach to protection against oesophago-tracheal reflux: at least lower oesophageal exclusion (4 cases) by ligation or anti-reflux operation. Oesophageal exclusion followed by oesophago-coloplasty is sometimes the only solution in cases of severe destruction of cervico-mediastinal tissues (2 cases: 1 cure). Five tracheal strictures required an associated resection-anastomosis (5 cures).
26例中有17例。它们在一段长时间的困难且感染性的重症监护后出现并发症，平均间隔30天。支气管镜检查确诊了该病，其还对瘘的部位和范围以及相关气管病变进行了良好评估。本系列中有5例死亡强调了这种并发症的严重性（1例在24小时后出现中毒感染综合征，2例因复苏预后无望而放弃治疗，2例食管气管反流本可预防）。不应等待自愈（尽管有2例确实自愈）。理想的直接缝合（9例：9例治愈）需要有利于愈合的局部条件和快速的呼吸自主。这些条件可通过积极预防食管气管反流来实现：至少进行低位食管闭锁（4例），通过结扎或抗反流手术。在颈纵隔组织严重破坏的情况下（2例：1例治愈），食管闭锁后继以食管结肠成形术有时是唯一的解决办法。5例气管狭窄需要进行相关的切除吻合术（5例治愈）。
