Baste Jean-Marc, Haddad Laura, Philouze Guillaume
a Department of General and Thoracic Surgery , Rouen University Hospital , Rouen , France.
Acta Chir Belg. 2018 Feb;118(1):52-55. doi: 10.1080/00015458.2017.1284466. Epub 2017 Jul 7.
Certain broncho-oesophageal fistulae require surgical repair. Herein, we describe an innovative surgical technique combining intercostal flap and endobronchial stenting.
Two patients, each with a with complex broncho-oesophageal fistula 2 years after radio-chemotherapy, were hospitalised for severe respiratory infection and extension of the fistula despite previous endoscopic treatment. The first patient presented with respiratory distress (ARDS). She had emergency surgery under extra corporeal membrane oxygenation: oesophagectomy and reconstruction of the left bronchus by a vascularised intercostal flap. Stenting was performed on day 10, due to persistence of the fistula. At 3 months the bronchus was healed, but the patient died of cerebral bleeding. For the second patient, repair was proposed before severe ARDS with the same surgical and ventilatory strategy and a stent was preventively inserted after surgery. After 3 months, the stent was removed and the left bronchus was healed.
Complex post-radiotherapy broncho-oesophageal fistulae should be treated surgically before respiratory complications arise, by combining reconstruction with a vascularised flap and transient stenting.
某些支气管食管瘘需要手术修复。在此，我们描述一种结合肋间皮瓣和支气管内支架置入的创新手术技术。
两名患者在放化疗后2年均患有复杂支气管食管瘘，尽管之前接受过内镜治疗，但因严重呼吸道感染和瘘管扩大而住院。第一名患者出现呼吸窘迫（急性呼吸窘迫综合征）。她在体外膜肺氧合支持下接受了急诊手术：食管切除术并采用带血管的肋间皮瓣重建左支气管。由于瘘管持续存在，在第10天进行了支架置入。3个月时支气管愈合，但患者死于脑出血。对于第二名患者，在严重急性呼吸窘迫综合征发生前采用相同的手术和通气策略进行修复，并在术后预防性置入支架。3个月后，取出支架，左支气管愈合。
放疗后复杂支气管食管瘘应在出现呼吸并发症之前进行手术治疗，可通过带血管皮瓣重建和临时支架置入相结合的方法。
