Division of Pulmonary and Critical Care, St Elizabeth Medical Center, Boston, MA, USA
Division of Pulmonary and Critical Care, St Elizabeth Medical Center, Boston, MA, USA.
Eur Respir Rev. 2020 Nov 5;29(158). doi: 10.1183/16000617.0094-2020. Print 2020 Dec 31.
Tracheo-oesophageal fistula (TOF) is a pathological connection between the trachea and the oesophagus that is associated with various underlying conditions including malignancies, infections, inhalation injuries and traumatic damage. As the condition spans multiple organ systems with varying aetiologies and acuities, TOF poses unique diagnostic and management challenges to pulmonologists, gastroenterologists and thoracic surgeons alike. Although stents have been a cornerstone in the management of TOF, there exists a large gap in our understanding of their efficacy and precise methodology, making stenting procedure both art and science. TOFs relating to underlying oesophageal or tracheal malignancies require advanced understanding of the airway and digestive tract anatomy, dimensions of the fistula, stent characteristics and types, and the interplay between the oesophageal stent and the airway stent if dual stenting procedure is elected. In this review article, we review the most up-to-date data on risk factors, clinical manifestations, diagnostic approaches, management methods and prognosis. Consequently, this article serves to evaluate current therapeutic strategies and the future directions in the areas of 3D-printed stents, over-the-scope clipping systems, tissue matrices and atrial septal closure devices.
气管食管瘘（TOF）是指气管与食管之间病理性的连通，与多种潜在疾病相关，包括恶性肿瘤、感染、吸入性损伤和创伤性损伤。由于该疾病跨越多个器官系统，具有不同的病因和严重程度，因此对肺病学家、胃肠病学家和胸外科医生来说，TOF 均存在独特的诊断和管理挑战。尽管支架一直是 TOF 治疗的基石，但我们对其疗效和确切方法的理解存在很大差距，这使得支架放置术既是一门艺术，也是一门科学。与食管或气管恶性肿瘤相关的 TOF 需要深入了解气道和消化道解剖结构、瘘管的尺寸、支架的特性和类型，以及在选择双支架置入术时食管支架和气道支架之间的相互作用。在这篇综述文章中，我们回顾了关于危险因素、临床表现、诊断方法、治疗方法和预后的最新数据。因此，本文旨在评估当前的治疗策略以及 3D 打印支架、过镜夹系统、组织基质和房间隔缺损封堵器等领域的未来发展方向。
