外科治疗继发的主动脉-食管瘘。
Surgical treatment for secondary aortoesophageal fistula.
机构信息
Department of Cardiac Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
出版信息
J Cardiothorac Surg. 2020 Sep 11;15(1):251. doi: 10.1186/s13019-020-01293-x.
BACKGROUND
Aortoesophageal fistula (AEF) is a relatively rare condition that is often life-threatening. Secondary AEF is a complication of previous surgery, which can be more critical and challenging than primary AEF. The number of secondary AEF is increasing due to increase in the number of thoracic endovascular aortic repair (TEVAR). Although TEVAR has become a successful alternative surgical strategy for thoracic aortic aneurysms, secondary AEF after TEVAR might be critical than other secondary AEF because of severe adhesion between the esophagus and residual thoracic aortic wall.
METHODS
This study analyzed six patients with secondary AEF who were treated at Tokyo Medical University Hospital between 2011 and 2016. These participants included four patients who had undergone TEVAR and two who had undergone total arch replacement.
RESULTS
Although they were subsequently hospitalized for a long period, open surgical repair was completed in two patients who had undergone total arch replacement. TEVAR alone was performed in two patients who had undergone TEVAR and they were discharged without major complications shortly. Combined repair of TEVAR as a bridge to open surgery was planned for two patients who had undergone TEVAR. However, reconstruction of the aorta and esophagus could not be completed in these patients due to severe adhesions, and they died during hospitalization.
CONCLUSIONS
Definitive open repair was successfully performed in patients with secondary AEF after total arch replacement. However, in the patients with secondary AEF after TEVAR, severe adhesion between the aorta and esophagus led to difficulty in performing a successful definitive open repair. The strategy for secondary AEF should, therefore, be decided considering the etiology of secondary AEF. In secondary AEF after TEVAR, definitive open repair is difficult to complete because of catastrophic complication, and palliative treatment using TEVAR without reconstruction of aorta and esophagus can be an alternative.
背景
主动脉食管瘘（AEF）是一种相对罕见的疾病，通常具有致命性。继发 AEF 是既往手术的并发症，比原发 AEF 更具危急和挑战性。由于胸主动脉腔内修复术（TEVAR）数量的增加，继发 AEF 的数量也在增加。尽管 TEVAR 已成为治疗胸主动脉瘤的一种成功的替代手术策略，但 TEVAR 后发生的继发 AEF 可能比其他继发 AEF 更为严重，因为食管和残余胸主动脉壁之间存在严重粘连。
方法
本研究分析了 2011 年至 2016 年期间在东京医科大学医院接受治疗的 6 例继发 AEF 患者。这些参与者包括 4 例接受 TEVAR 治疗的患者和 2 例接受全弓置换的患者。
结果
尽管这 2 例接受全弓置换的患者随后住院时间较长，但均成功完成了开放式手术修复。对 2 例接受 TEVAR 治疗的患者仅单独进行了 TEVAR，他们很快就没有出现重大并发症出院。对 2 例接受 TEVAR 治疗的患者计划采用 TEVAR 作为开放手术的桥梁进行联合修复。然而，由于严重粘连，这 2 例患者的主动脉和食管重建无法完成，他们在住院期间死亡。
结论
对接受全弓置换后的继发 AEF 患者成功进行了确定性开放修复。然而，在接受 TEVAR 治疗后的继发 AEF 患者中，主动脉和食管之间的严重粘连导致难以完成成功的确定性开放修复。因此，应根据继发 AEF 的病因来决定治疗策略。在 TEVAR 后发生的继发 AEF 中，由于灾难性并发症，确定性开放修复难以完成，而不重建主动脉和食管的 TEVAR 姑息治疗可能是一种替代方法。
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