Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Ann Thorac Surg. 2018 Dec;106(6):1640-1646. doi: 10.1016/j.athoracsur.2018.06.076. Epub 2018 Aug 29.
Post-esophagectomy tracheo-bronchial-esophageal fistula (PETEF) most often develops after anastomotic disruption or gastric conduit necrosis. Ideal surgical management and outcomes for this complication are uncertain.
A retrospective review of 11 patients undergoing surgical repair of PETEF was performed.
The median time between esophagectomy and surgical repair of PETEF was 61 days (range, 7 days to 28 years). Anastomotic leak or gastric conduit necrosis was responsible for PETEF in 6 patients (54.5%), whereas other causes were erosion of a tracheal appliance (n = 2), gastric conduit staple line erosion (n = 1), anastomotic stricture dilation (n = 1), and recurrent esophageal cancer (n = 1). Membranous airway defects were repaired primarily and buttressed with muscle or omental flaps in 8 patients (72.7%), whereas two (18.2%) were repaired with bio-prosthetic patches and one (9.1%) was repaired with a sleeve resection of the bronchus. Anastomotic and neo-esophageal conduit defects were repaired primarily in 3 patients (27.3%), whereas 7 patients (63.6%) underwent conduit take-down and esophageal or pharyngeal diversion, and 1 patient (9.1%) underwent simultaneous fistula repair and colon interposition. Two patients (18.2%) had recurrent fistulas, with 1 patient dying after second fistula closure and the other was discharged with no further attempt at repair. Three patients (27.3%) died postoperatively. Only 3 patients (27.3%) resumed an oral diet after fistula repair.
Surgical treatment is effective for most patients undergoing operative repair of PETEF, notwithstanding a considerable risk of postoperative morbidity and death. Although fistula repair is life saving and prevents further respiratory deterioration, return to oral alimentation is not ensured.
食管切除术后气管-支气管-食管瘘（PETEF）多发生于吻合口破裂或胃管坏死。对于这种并发症，理想的手术治疗和结果尚不确定。
回顾性分析 11 例接受 PETEF 手术修复的患者。
食管切除术后至 PETEF 手术修复的中位时间为 61 天（范围，7 天至 28 年）。6 例（54.5%）患者因吻合口漏或胃管坏死导致 PETEF，而其他原因包括气管器械侵蚀（n=2）、胃管吻合钉线侵蚀（n=1）、吻合口狭窄扩张（n=1）和复发性食管癌（n=1）。8 例（72.7%）患者的膜性气道缺损采用一期修复，并辅以肌肉或大网膜瓣加固，2 例（18.2%）采用生物假体补丁修复，1 例（9.1%）采用支气管袖状切除修复。3 例（27.3%）患者的吻合口和新食管管腔缺损采用一期修复，7 例（63.6%）患者进行管腔切除和食管或咽分流，1 例（9.1%）患者同时进行瘘管修复和结肠间置。2 例（18.2%）患者出现复发性瘘，其中 1 例在第二次瘘关闭后死亡，另 1 例出院后未再尝试修复。3 例（27.3%）患者术后死亡。只有 3 例（27.3%）患者在瘘管修复后恢复口服饮食。
尽管术后发病率和死亡率较高，但手术治疗对大多数接受 PETEF 手术修复的患者有效。尽管瘘管修复可以挽救生命并防止进一步的呼吸恶化，但不能保证恢复口服饮食。
