Zhao Jinbo, Ma Nan, Zhao Zhengwei, Lei Jie, Lu Qiang, Tian Feng, Zhou Yongan, Han Yong, Li Xiaofei
Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
Department of Ophthalmology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
J Thorac Dis. 2017 Jan;9(1):187-193. doi: 10.21037/jtd.2017.01.11.
Colobronchial fistula (CBF) is rare and easy to be delayed in clinic. There is no systemic study about this disease. The pathogenesis, clinical presentations, diagnosis and treatment of CBF were analyzed in this study.
The clinical data from 37 cases of CBF, which included one case in our institute and the other 36 cases in literature from January 1960 to August 2016, were reviewed and analyzed. The etiology, clinical presentations, diagnostic and therapeutic methods, and outcomes were summarized.
The causes of CBF included Crohn's disease, postoperative intraperitoneal adhesion, diaphragmatic hernia, pulmonary infection or abscess, colonic malignancy, colonic interposition, radiation, hyperthermic intraperitoneal chemotherapy (HIPEC), diaphragmatic mesh repair, pulmonary tuberculosis and pyonephrosis. Based on the anatomical location and the causes of fistula, CBF were divided into four types: type I, CBF secondary to the adhesion among colon, diaphragm and lung; type II, CBF secondary to diaphragmatic hernia; type III, CBF secondary to sub diaphragmatic abscess or emphysema; type VI, CBF secondary to colon interposition. The characteristic clinical presentations of CBF was productive cough with foul smelling sputum (78.38%), most of the patients were finally confirmed the diagnosis by barium enema or water-soluble contrast enema study (67.57%) and computer tomography (CT) scan/with multiplanar reconstruction (16.22%); 35 cases (94.59%) accepted the surgical treatment. Among 31 patients with recorded follow-up data, 26 patients recovered unevenly, but 5 patients died in 1 month after treatment.
CBF is a rare but can not be ignored disease. Anything which may induce the direct or indirect connection between colon and lung tissue may result in CBF. Productive cough with foul smelling sputum is the characteristic symptom. Radiological investigations such as barium enema and/or CT scan with multiplanar reconstruction are valuable for the confirmation of CBF. Surgery based on the etiology is the foundation of treatment.
支气管结肠瘘（CBF）较为罕见，在临床上容易被延误诊断。目前尚无关于该疾病的系统性研究。本研究对CBF的发病机制、临床表现、诊断及治疗进行了分析。
回顾性分析37例CBF患者的临床资料，其中包括我院1例以及1960年1月至2016年8月文献报道的36例。总结其病因、临床表现、诊断及治疗方法和结果。
CBF的病因包括克罗恩病、术后腹腔粘连、膈疝、肺部感染或脓肿、结肠恶性肿瘤、结肠间置术、放疗、腹腔内热灌注化疗（HIPEC）、膈肌补片修补术、肺结核和肾积脓。根据瘘管的解剖位置和病因，CBF分为四种类型：Ⅰ型，继发于结肠、膈肌和肺之间粘连的CBF；Ⅱ型，继发于膈疝的CBF；Ⅲ型，继发于膈下脓肿或气肿的CBF；Ⅵ型，继发于结肠间置术的CBF。CBF的特征性临床表现为咳出恶臭痰液（78.38%），大多数患者最终通过钡剂灌肠或水溶性造影剂灌肠检查（67.57%）以及计算机断层扫描（CT）/多平面重建（16.22%）得以确诊；35例（94.59%）接受了手术治疗。在有随访记录的31例患者中，26例恢复情况不一，但5例在治疗后1个月内死亡。
CBF是一种罕见但不容忽视的疾病。任何可能导致结肠与肺组织直接或间接相连的因素都可能引发CBF。咳出恶臭痰液是其特征性症状。钡剂灌肠和/或CT多平面重建等影像学检查对于CBF的确诊具有重要价值。根据病因进行手术是治疗的基础。
