Hilgenberg A D, Grillo H C
J Thorac Cardiovasc Surg. 1983 Apr;85(4):492-8.
Acquired tracheoesophageal fistula (TEF) caused by cuffed tracheal tubes, surgical trauma, and blunt injuries is an unusual and serious problem. Several differing approaches to management have been proposed. We have repaired such fistulas in 20 patients; 14 of them were related to tracheal intubation, three to blunt trauma, two followed anterior cervical spine fusions, and one resulted from a foreign body. Fistula closure on ventilator-dependent patients was usually delayed until they were weaned from respiratory support. Four patients had esophageal diversion before repair of their fistulas. There was sufficient tracheal damage to require resection and end-to-end anastomosis in 13 patients. The esophageal defect was closed directly in 16 patients, and end-to-end reconstruction of the esophagus was accomplished in four. There were two deaths, and one fistula recurrence required reoperation. These results support our recommendations to delay fistula closure in most ventilator patients, to use esophageal diversion selectively, to employ tracheal resection when there is evidence of extensive damage, and to directly repair the esophagus.
由带套囊气管导管、手术创伤和钝性损伤引起的后天性气管食管瘘（TEF）是一个罕见且严重的问题。针对其处理已提出了几种不同的方法。我们已为20例患者修复了此类瘘管；其中14例与气管插管有关，3例与钝性创伤有关，2例继发于颈椎前路融合术，1例由异物导致。对于依赖呼吸机的患者，瘘管闭合通常会推迟至他们脱离呼吸支持。4例患者在瘘管修复前进行了食管改道。13例患者存在足够的气管损伤，需要进行气管切除及端端吻合。16例患者直接闭合了食管缺损，4例完成了食管端端重建。有2例死亡，1例瘘管复发需要再次手术。这些结果支持我们的建议，即在大多数依赖呼吸机的患者中推迟瘘管闭合，选择性地使用食管改道，在有广泛损伤证据时进行气管切除，并直接修复食管。
