Fukumoto Yoji, Matsunaga Tomoyuki, Shishido Yuji, Amisaki Masataka, Kono Yusuke, Murakami Yuki, Kuroda Hirohiko, Osaki Tomohiro, Sakamoto Teruhisa, Honjo Soichiro, Ashida Keigo, Saito Hiroaki, Fujiwara Yoshiyuki
Division of Surgical Oncology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan.
Surg Case Rep. 2018 May 23;4(1):49. doi: 10.1186/s40792-018-0458-8.
Treatment for tracheoesophageal fistula (TEF), a life-threatening complication after esophagectomy, is challenging.
A 75-year-old man with thoracic esophageal cancer underwent subtotal esophagectomy and gastric tube reconstruction through the post-mediastinal root after neoadjuvant chemotherapy. Owing to postoperative anastomotic leakage, an abscess formed at the anastomotic region. Sustained inflammation from the abscess caused refractory TEF between the esophagogastric anastomotic site and membrane of the trachea, and several conservative therapies for TEF failed. Hence, the patient underwent surgery including division of the fistula, direct suturing of the leakage sites, and reinforcement with the flap of the thymus pedicle. As a result, the abscess and TEF disappeared after surgery and the patient was immediately administered an oral diet and discharged home 103 days after initial surgery.
Although pedicle flaps for the reinforcement of TEF are usually obtained from muscle or pericardium, these flaps need enough lengths to overcome moving distance. We are the first in the existing literature to have successfully treated TEF with surgical repair using a thymus flap located close to TEF. The thymus pedicle might be another candidate for the reinforcement flap in TEF.
气管食管瘘（TEF）是食管切除术后一种危及生命的并发症，其治疗具有挑战性。
一名75岁的胸段食管癌男性患者在新辅助化疗后接受了次全食管切除术，并通过后纵隔根部进行胃管重建。由于术后吻合口漏，在吻合区域形成了脓肿。脓肿持续的炎症导致食管胃吻合口与气管膜之间形成难治性TEF，几种TEF保守治疗均失败。因此，患者接受了手术，包括瘘管分离、漏口直接缝合以及用带蒂胸腺瓣加固。结果，术后脓肿和TEF消失，患者术后立即开始经口进食，并在初次手术后103天出院。
虽然用于加固TEF的带蒂皮瓣通常取自肌肉或心包，但这些皮瓣需要足够的长度来克服移动距离。我们是现有文献中首个使用靠近TEF的胸腺瓣进行手术修复成功治疗TEF的。胸腺蒂可能是TEF加固皮瓣的另一个候选者。
