Yamanaka Ken, Shiiya Norihiko, Washiyama Naoki, Sato Masanori
First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Interact Cardiovasc Thorac Surg. 2017 Aug 1;25(2):331-332. doi: 10.1093/icvts/ivx112.
Secondary graft-oesophageal fistula is a fatal complication of aortic arch replacement. We report a successful two-stage surgical management of a graft-oesophageal fistula seen in a 68-year-old woman 3 years after total aortic arch replacement. She presented with a prolonged intractable fever without haematemesis. The fistula occurred between the distal aortic anastomosis and oesophagus; the entire graft was surrounded by air. In the first-stage operation, we performed re-replacement of the entire infected graft, oesophagectomy with cervical oesophagostomy, omental transfer and cervical routing of the stomach roll, through an extended left thoracotomy incision with sternal transection. Intravenous antibiotics were administered for 6 weeks; the second-stage cervico-oesophageal anastomosis was performed 57 days later. She was discharged without complications and is doing well 6 months postoperatively.
人工血管-食管瘘是主动脉弓置换术的一种致命并发症。我们报告了一例在全主动脉弓置换术后3年出现人工血管-食管瘘的68岁女性患者，成功接受了两阶段手术治疗。她表现为持续顽固性发热，无呕血。瘘发生在主动脉远端吻合口与食管之间；整个移植物被气体包围。在第一阶段手术中，我们通过延长的左胸切口并横断胸骨，进行了整个感染移植物的再次置换、食管切除术并做颈部食管造口术、大网膜转移和胃管颈部改道。静脉注射抗生素6周；57天后进行了第二阶段的颈-食管吻合术。她出院时无并发症，术后6个月情况良好。
