Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China.
Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Henan, China.
Thorac Cardiovasc Surg. 2024 Mar;72(2):156-161. doi: 10.1055/a-2122-7149. Epub 2023 Jul 4.
Thoracogastric airway fistula (TGAF) is a fatal complication after esophagectomy. Without active treatment, patients may die of intractable pneumonia, sepsis, massive hemoptysis, or respiratory failure. We determined the clinical value of the two-tube method that involves the precise interventional placement of the nasojejunal tube (NJT) and nasogastric tube (NGT) for TGAF.
Clinical data of patients with TGAF who had undergone fluoroscopic interventional placement of NJT and NGT were analyzed retrospectively. The paired -test was used to compare the index values before and after treatment. Statistical significance was set at < 0.05.
In total, 212 patients (177 male and 35 female; mean age, 61.3 ± 7.9 years [47-73]) with TGAF who had undergone the two-tube method were included. Posttreatment chest spiral computed tomography and inflammatory indicators showed significantly improved pulmonary inflammation compared with that before treatment. The patients' general condition remained stable. Of 212 patients, 12 (5.7%) underwent surgical repair, 108 (50.9%) received placement of airway stents, and 92 (43.4%) cases only continued treatment with the two-tube method owing to patients' conditions. In total, 47.8% (44/92) patients died of secondary pulmonary infection, bleeding, and primary tumor progression, whereas 52.2% (48/92) patients survived with both tubes.
The two-tube method, which involves the precise interventional placement of the NJT and NGT, is simple, safe, and effective for treating TGAF. This method is a bridge for successive treatments or a treatment itself for patients who are unsuitable for surgical repair or stent placement.
胸胃气道瘘（TGAF）是食管切除术后的一种致命并发症。如果不积极治疗，患者可能会死于难治性肺炎、败血症、大咯血或呼吸衰竭。我们确定了双管法的临床价值，该方法涉及鼻空肠管（NJT）和鼻胃管（NGT）的精确介入放置，用于治疗 TGAF。
回顾性分析经荧光透视介入放置 NJT 和 NGT 治疗 TGAF 患者的临床资料。采用配对 t 检验比较治疗前后各项指标。统计显著性水平设为<0.05。
共纳入 212 例（男 177 例，女 35 例；平均年龄 61.3±7.9 岁[47-73]）采用双管法治疗的 TGAF 患者。治疗后螺旋 CT 胸部和炎症指标显示肺部炎症明显改善。患者一般情况稳定。212 例患者中，12 例（5.7%）行手术修复，108 例（50.9%）行气道支架置入，92 例（43.4%）因患者情况仅继续采用双管法治疗。总共有 47.8%（44/92）例患者因继发性肺部感染、出血和原发肿瘤进展而死亡，而 52.2%（48/92）例患者存活并继续使用双管。
双管法，即 NJT 和 NGT 的精确介入放置，对于治疗 TGAF 简单、安全、有效。对于不适合手术修复或支架置入的患者，该方法是连续治疗的桥梁或治疗本身。
