Graeber G M, Farrell B G, Neville J F, Parker F B
Ann Thorac Surg. 1980 Jun;29(6):555-61. doi: 10.1016/s0003-4975(10)61706-7.
The patient presented in this report is unique in that he survived two aortobronchial fistulas. With such fistulas, intermittent hemoptysis is always present; pain is an infrequent symptom. Plain roentgenograms of the chest are helpful in denoting the presence of an aneurysm and the affected portion of the tracheobronchial tree. Aortography rarely demonstrates the fistula. Bronchoscopy should be conducted only with care when the diagnosis is in doubt since disaster can attend disruption of the clot in the fistula. Successful repair usually requires maintenance of distal circulation, repair of the aorta either by closure or by graft replacement, and repair of the tracheobronchial tree either by resection or primary suture. Anesthesia management should include selective endobronchial intubation to control possible intraoperative hemorrhage. Interposition of healthy living tissue to protect the suture lines is encouraged to prevent recurrence.
本报告中所呈现的患者非常独特，他经历了两次主动脉支气管瘘却存活了下来。患有此类瘘管时，总是会出现间歇性咯血；疼痛则是不常见的症状。胸部X线平片有助于显示动脉瘤的存在以及气管支气管树的受累部位。主动脉造影很少能显示出瘘管。当诊断存疑时，支气管镜检查应谨慎进行，因为瘘管内血栓破裂可能会引发灾难。成功修复通常需要维持远端循环，通过缝合或移植置换来修复主动脉，以及通过切除或一期缝合来修复气管支气管树。麻醉管理应包括选择性支气管内插管，以控制术中可能出现的出血。鼓励置入健康的活体组织来保护缝合线，以防止复发。
