Bibas Benoit Jacques, Guerreiro Cardoso Paulo Francisco, Minamoto Helio, Eloy-Pereira Leandro Picheth, Tamagno Mauro Federico L, Terra Ricardo Mingarini, Pêgo-Fernandes Paulo Manoel
Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Ann Thorac Surg. 2016 Oct;102(4):1081-7. doi: 10.1016/j.athoracsur.2016.04.029. Epub 2016 Jun 18.
Benign tracheoesophageal fistulas (TEFs) are rare, and surgical correction is the ideal method of treatment. The objective of this study was to evaluate the results of operative treatment of benign TEFs in patients from a tertiary referral center.
Retrospective study of patients with benign TEFs who were treated between January 2005 and December 2014. Preoperative evaluation included computed tomography of the chest, bronchoscopy, and upper endoscopy. Preoperative treatment included nutritional support by gastrostomy and treatment of lung infections. Surgical repair was done with tracheal resection and reconstruction, laryngotracheal resection, or membranous tracheal repair without resection. Esophageal management consisted of two-layer closure.
Twenty patients (11 men) with mean age 48 ± 17 years were included. The most frequent cause was postintubation injury (n = 16; 80%). The median TEF length was 9 mm (interquartile range [IQR], 2 to 25 mm). The most commonly used surgical approaches were cervicotomy (n = 15; 75%) and cervicosternotomy (n = 3; 15%). Eleven patients required tracheal resection; median length was 3 cm (IQR, 3 to 5.5 cm). Seven patients (35%) required intraoperative tracheostomy. Complications occurred in 55% of patients. There was one dehiscence of the tracheal anastomosis, and one procedure-related death. Ninety-five percent of patients had complete closure of the TEF occurred in 95% of cases. Two patients had tracheal stenosis recurrence, and one patient had both TEF and tracheal stenosis recurrence. Two patients have indwelling silicone tracheal stents.
Surgical treatment of TEF is effective. Nonetheless, morbidity and mortality are not negligible, even when performed at a referral center and after appropriate preoperative evaluation.
良性气管食管瘘（TEF）较为罕见，手术矫正为理想的治疗方法。本研究目的是评估来自三级转诊中心的患者良性TEF手术治疗的结果。
对2005年1月至2014年12月间接受治疗的良性TEF患者进行回顾性研究。术前评估包括胸部计算机断层扫描、支气管镜检查和上消化道内镜检查。术前治疗包括胃造口术营养支持和肺部感染治疗。手术修复采用气管切除重建、喉气管切除或无切除的膜性气管修复。食管处理采用两层缝合。
纳入20例患者（11例男性），平均年龄48±17岁。最常见的病因是插管后损伤（n = 16；80%）。TEF中位长度为9 mm（四分位数间距[IQR]，2至25 mm）。最常用的手术入路是颈部切开术（n = 15；75%）和颈胸骨切开术（n = 3；15%）。11例患者需要气管切除；中位长度为3 cm（IQR，3至5.5 cm）。7例患者（35%）术中需要气管切开。55%的患者发生并发症。气管吻合口有1例裂开，1例与手术相关的死亡。95%的患者TEF完全闭合。2例患者气管狭窄复发，1例患者TEF和气管狭窄均复发。2例患者留置硅胶气管支架。
TEF的手术治疗是有效的。尽管如此，即使在转诊中心进行手术并经过适当的术前评估，发病率和死亡率也不容小觑。
