Kim Sang Pil, Lee Juhyun, Lee Sung Kwang, Kim Do Hyung
Department of Thoracic and Cardiovascular Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Inje University Busan Paik Hospital, Busan, Korea.
J Chest Surg. 2021 Jun 5;54(3):206-213. doi: 10.5090/jcs.21.012.
Tracheoesophageal fistula (TEFs) is a rare condition that requires complex surgical treatment. We analyzed the surgical outcomes of TEF reported in the literature and at Pusan National University Yangsan Hospital using standardized techniques.
This retrospective study included 8 patients diagnosed with acquired benign TEF between March 2010 and December 2019. The surgical method was determined based on the size of the fistula observed within the endoscope.
TEF occurred in 7 patients (87.5%) after intubation or tracheostomy and in 1 patient (12.5%) after esophageal surgery due to conduit necrosis. For tracheal management, 5 and 2 patients underwent tracheal resection and end-to-end anastomosis and primary repair, respectively. The median length of resection was 2.5 cm (range, 1.3-3.4 cm). For esophageal management, 6 patients underwent primary repair and 1 patient underwent esophageal diversion. One patient underwent TEF division with a stapler. Interposition of a muscle flap was performed in 2 patients. TEF recurrence, esophageal stenosis, and dehiscence or granulation occurred in 1, 1, and 2 patients, respectively. A long-term tracheostomy tube or T-tube was used in 2 patients for >2 months.
Although TEF surgery is complex and challenging, good results can be achieved if surgical standards are established and experience is accumulated.
气管食管瘘（TEF）是一种罕见疾病，需要复杂的手术治疗。我们使用标准化技术分析了文献报道的以及釜山国立大学梁山医院的TEF手术结果。
这项回顾性研究纳入了2010年3月至2019年12月期间诊断为后天性良性TEF的8例患者。手术方法根据在内窥镜下观察到的瘘口大小确定。
7例患者（87.5%）的TEF发生于插管或气管切开术后，1例患者（12.5%）的TEF发生于因管道坏死而行食管手术后。对于气管处理，5例和2例患者分别接受了气管切除及端端吻合术和一期修复。切除的中位长度为2.5 cm（范围1.3 - 3.4 cm）。对于食管处理，6例患者接受了一期修复，1例患者接受了食管转流术。1例患者使用吻合器进行了TEF分离。2例患者进行了肌瓣置入。分别有1例、1例和2例患者发生了TEF复发、食管狭窄以及裂开或肉芽形成。2例患者长期使用气管造口管或T形管超过2个月。
尽管TEF手术复杂且具有挑战性，但如果建立手术标准并积累经验，可取得良好效果。
