Vanstraelen Stijn, Vos Robin, Dausy Marie, Van Slambrouck Jan, Vanluyten Cedric, De Leyn Paul, Coosemans Willy, Decaluwé Herbert, Van Veer Hans, Depypere Lieven, Bisschops Raf, Demedts Ingrid, Casaer Michael P, Debaveye Yves, De Vlieger Greet, Godinas Laurent, Verleden Geert, Van Raemdonck Dirk, Nafteux Philippe, Ceulemans Laurens J
Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium.
Transplant Direct. 2024 Feb 26;10(3):e1593. doi: 10.1097/TXD.0000000000001593. eCollection 2024 Mar.
Lung transplantations are highly complex procedures, often conducted in frail patients. Through the addition of immunosuppressants, healing can be compromised, primarily leading to the development of bronchopleural fistulas. Although esophageal fistulas (EFs) after lung transplantation remain rare, they are associated with significant morbidity. We aimed to investigate the clinical presentation, diagnostic approaches, and treatment strategies of EF after lung transplantation.
All patients who developed EF after lung transplantation at the University Hospitals Leuven between January 2019 and March 2022 were retrospectively reviewed and the clinical presentations, diagnostic approaches, and treatment strategies were summarized.
Among 212 lung transplantation patients, 5 patients (2.4%) developed EF. Three patients were male and median age was 39 y (range, 34-63). Intraoperative circulatory support was required in 3 patients, with 2 needing continued support postoperatively. Bipolar energy devices were consistently used for mediastinal hemostasis. All EFs were right-sided. Median time to diagnosis was 28 d (range, 12-48) and 80% of EFs presented as recurrent respiratory infections or empyema. Diagnosis was made through computed tomography (n = 3) or esophagogastroscopy (n = 2). Surgical repair with muscle flap covering achieved an 80% success rate. All patients achieved complete resolution, with only 1 patient experiencing a fatal outcome during a complicated EF-related recovery.
Although EF after lung transplantation remains rare, vigilance is crucial, particularly in cases of right-sided intrathoracic infection. Moreover, caution must be exercised when applying thermal energy in the mediastinal area to prevent EF development and mitigate the risk of major morbidity. Timely diagnosis and surgical intervention can yield favorable outcomes.
肺移植是高度复杂的手术，通常在身体虚弱的患者中进行。通过添加免疫抑制剂，愈合可能会受到影响，主要导致支气管胸膜瘘的发生。尽管肺移植后食管瘘（EFs）仍然罕见，但它们与显著的发病率相关。我们旨在研究肺移植后EF的临床表现、诊断方法和治疗策略。
对2019年1月至2022年3月在鲁汶大学医院接受肺移植后发生EF的所有患者进行回顾性研究，并总结其临床表现、诊断方法和治疗策略。
在212例肺移植患者中，5例（2.4%）发生了EF。3例为男性，中位年龄为39岁（范围34 - 63岁）。3例患者术中需要循环支持，2例术后需要持续支持。纵隔止血一直使用双极能量设备。所有EF均发生在右侧。诊断的中位时间为28天（范围12 - 48天），80%的EF表现为反复呼吸道感染或脓胸。通过计算机断层扫描（n = 3）或食管胃镜检查（n = 2）进行诊断。采用肌瓣覆盖的手术修复成功率达到80%。所有患者均完全康复，只有1例患者在与EF相关的复杂恢复过程中出现致命结局。
尽管肺移植后EF仍然罕见，但保持警惕至关重要，特别是在右侧胸腔内感染的情况下。此外，在纵隔区域应用热能时必须谨慎，以防止EF的发生并降低严重发病的风险。及时诊断和手术干预可取得良好效果。
