Mills Alexander, Tanaka Akiko, Dawson Ashley, Hetz Robert, Smith Holly, Lopez Michael, Safi Hazim, Estrera Anthony
Department of General Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex.
Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex.
JTCVS Open. 2024 Apr 16;19:31-38. doi: 10.1016/j.xjon.2024.04.004. eCollection 2024 Jun.
Aortoesophageal fistula is a rare, life-threatening condition. There is no consensus regarding the surgical management of the esophagus in this condition.
We retrospectively evaluated 13 patients diagnosed with aortoesophageal fistulas at a single institution from 2003 to 2021. Descriptive statistics were used to analyze patient characteristics, operative characteristics, and patient outcomes. Kaplan-Meier survival analysis was performed.
Patients' mean age was 63.5 years, and 6 (46.2%) were female. The most common presenting symptoms were hemoptysis/hematemesis (69.2%), chest/back pain (46.2%), and fever (38.5%). Twelve patients (92.3%) had a history of aortic procedures. The median time between the index operation and repair of the secondary aortoesophageal fistula in the 12 patients was 5 months. The index operation was a thoracic endovascular aortic repair in 10 of 12 patients (83.3%). Eleven patients (84.6%) underwent primary esophageal repair with flap coverage (omentum or muscle). One of these patients needed an esophagectomy within 1 year. The primary surgical management of the aorta was graft excision and replacement, aside from 1 patient who underwent primary repair. The 30-day survival was 69.2%, and 1-year and 5-year survivals were 31.7%. There were no recurrent infections at the esophageal fistula site.
Aortoesophageal fistula remains a rare condition, but its case numbers have increased with thoracic endovascular aortic repair. It continues to be a difficult condition to manage and has a high fatality rate. Esophageal-preserving surgery may be a safe and less-invasive option for patients with a small defect.
主动脉食管瘘是一种罕见的、危及生命的疾病。对于这种疾病中食管的外科治疗尚无共识。
我们回顾性评估了2003年至2021年在单一机构诊断为主动脉食管瘘的13例患者。采用描述性统计分析患者特征、手术特征和患者预后。进行了Kaplan-Meier生存分析。
患者的平均年龄为63.5岁，6例（46.2%）为女性。最常见的表现症状为咯血/呕血（69.2%）、胸痛/背痛（46.2%）和发热（38.5%）。12例患者（92.3%）有主动脉手术史。12例患者中，初次手术与二次主动脉食管瘘修复之间的中位时间为5个月。12例患者中有10例（83.3%）的初次手术为胸段血管腔内主动脉修复术。11例患者（84.6%）接受了带瓣覆盖（网膜或肌肉）的一期食管修复术。其中1例患者在1年内需要进行食管切除术。除1例接受初次修复的患者外，主动脉的主要手术治疗方法是移植物切除和置换。30天生存率为69.2%，1年和5年生存率分别为31.7%。食管瘘部位无复发性感染。
主动脉食管瘘仍然是一种罕见疾病，但随着胸段血管腔内主动脉修复术的开展，其病例数有所增加。它仍然是一种难以处理的疾病，病死率很高。对于缺损较小的患者，保留食管的手术可能是一种安全且侵入性较小的选择。
