Mattioli Francesco, Serafini Edoardo, Andreani Alessandro, Cappiello Gaia, Marchioni Daniele, Pinelli Massimo, Tonelli Roberto, Clini Enrico, Marchioni Alessandro
Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy.
Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
Front Surg. 2023 Apr 27;10:1107461. doi: 10.3389/fsurg.2023.1107461. eCollection 2023.
Radiotherapy and esophageal stenting are usually employed to manage esophageal localization of distant cancer. However, they are also related to the occurrence of an increased risk of tracheoesophageal fistula. Tracheoesophageal fistula management in these patients involves dealing with poor general conditions and short-term prognosis. This paper presents the first case in literature of bronchoscopic fistula closure through an autologous fascia lata graft placement between two stents.
A 67-years-old male patient was diagnosed with pulmonary squamous cell carcinoma in the inferior lobe of the left lung with mediastinal lymph node metastasis. After a multidisciplinary discussion, bronchoscopic repair of tracheoesophageal fistula with autologous fascia lata was decided without the removal of the esophageal stent due to the high risk on the esophagus possibly related to such a procedure. Oral feeding was progressively introduced without the development of aspiration symptoms. Videofluoroscopy and esophagogastroduodenoscopy were performed at 7 months showing no signs of tracheoesophageal fistula patency.
This technique might represent a low risks viable option for patients unsuitable for open surgical approaches.
放射治疗和食管支架置入术通常用于处理远处癌症的食管定位。然而，它们也与气管食管瘘风险增加的发生有关。这些患者的气管食管瘘处理涉及应对一般状况较差和短期预后不佳的问题。本文介绍了文献中首例通过在两个支架之间置入自体阔筋膜进行支气管镜下瘘口闭合的病例。
一名67岁男性患者被诊断为左肺下叶肺鳞状细胞癌伴纵隔淋巴结转移。经过多学科讨论，由于食管支架移除手术可能对食管造成的高风险，决定在不移除食管支架的情况下，采用自体阔筋膜进行气管食管瘘的支气管镜修复。逐渐恢复经口进食，未出现误吸症状。7个月时进行了视频透视和食管胃十二指肠镜检查，结果显示没有气管食管瘘通畅的迹象。
对于不适合开放手术的患者，该技术可能是一种低风险的可行选择。
