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胸段食管切除、胸锁乳突肌旋转皮瓣联合组织黏合剂注射治疗后气管-胃通道瘘的成功管理

Successful Management of a Tracheo-gastric Conduit Fistula after a Three-field Esophagectomy with Combined Sternocleidomastoid Muscle Rotation Flap and Histoacryl Injection Treatment.

作者信息

Chung Yoon Ji, Kim Ji Hyun, Kim Dong Jin, Kim Jin Jo

机构信息

Department of Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

出版信息

J Gastric Cancer. 2020 Dec;20(4):454-460. doi: 10.5230/jgc.2020.20.e38. Epub 2020 Dec 28.

DOI:10.5230/jgc.2020.20.e38
PMID:33425446
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7781752/
Abstract

Tracheo-gastric conduit fistula is an extremely rare but severe complication that is difficult to manage. Conservative care, esophageal or tracheal stent placement, or cutaneomuscular flaps have been suggested; however, no definite treatment has been proven. We report a case of tracheo-gastric conduit fistula that occurred after a minimally invasive radical three-field esophagectomy. Following the primary surgery, the diagnosis was made while evaluating the patient's frequent aspiration and coughing. Conservative management failed, and a surgical correction was undertaken to identify the multifocal mucosal defect and exposed tracheal ring. A sternocleidomastoid muscle rotation flap and subsequent Histoacryl injection into the remaining fistula were performed, and the fistula was successfully managed.

摘要

气管-胃管道瘘是一种极其罕见但严重的并发症，难以处理。有人提出采用保守治疗、放置食管或气管支架或皮肌瓣；然而，尚未证实有明确的治疗方法。我们报告一例微创根治性三野食管切除术后发生气管-胃管道瘘的病例。初次手术后，在评估患者频繁误吸和咳嗽时做出诊断。保守治疗失败后，进行了手术矫正，以确定多灶性黏膜缺损和暴露的气管环。采用胸锁乳突肌旋转瓣并随后向剩余瘘管注射组织黏合剂，成功处理了瘘管。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41e6/7781752/8617f7d62166/jgc-20-454-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41e6/7781752/827761930f6a/jgc-20-454-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41e6/7781752/079585142458/jgc-20-454-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41e6/7781752/b81cc00bd973/jgc-20-454-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41e6/7781752/a30a15c58f41/jgc-20-454-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41e6/7781752/8617f7d62166/jgc-20-454-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41e6/7781752/827761930f6a/jgc-20-454-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41e6/7781752/079585142458/jgc-20-454-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41e6/7781752/b81cc00bd973/jgc-20-454-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41e6/7781752/a30a15c58f41/jgc-20-454-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41e6/7781752/8617f7d62166/jgc-20-454-g005.jpg

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本文引用的文献

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Novel technique to repair a bronchopleural fistula after esophagectomy using wide intercostal muscle flap fixed by azygos vein and bronchus: a case report.使用经奇静脉和支气管固定的宽肋间肌瓣修复食管切除术后支气管胸膜瘘的新技术：病例报告
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Endoscopic treatment of esophageal fistulas after esophagectomy with injection of an alpha-cyanoacrylate monomer: a phase II study.内镜下注射α-氰基丙烯酸酯单体治疗食管切除术后食管瘘：一项II期研究
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Surgical Management of Post-Esophagectomy Tracheo-Bronchial-Esophageal Fistula.
食管切除术后气管-支气管-食管瘘的外科治疗。
Ann Thorac Surg. 2018 Dec;106(6):1640-1646. doi: 10.1016/j.athoracsur.2018.06.076. Epub 2018 Aug 29.
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Successful endoscopic management of a persistent bronchobiliary fistula with Histoacryl/Lipiodol mixture.使用组织黏合剂/碘油混合物成功进行内镜治疗持续性支气管胆管瘘。
Ann R Coll Surg Engl. 2018 Apr;100(4):e73-e77. doi: 10.1308/rcsann.2018.0026. Epub 2018 Mar 15.
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Postesophagectomy airway-gastric fistula successfully treated with subcutaneous fascia flap, tracheal reconstruction, and gastric fistula drainage: A case report and literature review.食管切除术后气管-胃瘘经皮下筋膜瓣、气管重建及胃瘘引流成功治疗：一例报告及文献综述
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Pitfalls in histoacryl glue injection therapy for oesophageal, gastric and ectopic varices: A review.组织黏合剂注射疗法治疗食管、胃及异位静脉曲张的陷阱：综述
World J Gastrointest Surg. 2016 Nov 27;8(11):729-734. doi: 10.4240/wjgs.v8.i11.729.
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Esophagectomy and Gastric Pull-through Procedures: Surgical Techniques, Imaging Features, and Potential Complications.食管切除术和胃上提术：手术技术、影像学特征及潜在并发症
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Closure of esophagotracheal fistula after esophagectomy for esophageal cancer.食管癌食管切除术后食管气管瘘的闭合
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International Consensus on Standardization of Data Collection for Complications Associated With Esophagectomy: Esophagectomy Complications Consensus Group (ECCG).食管癌切除术后并发症数据收集标准化国际共识：食管癌切除术后并发症共识小组（ECCG）
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Epidemiology of esophageal cancer.食管癌的流行病学。
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