Dartevelle P, Macchiarini P
Department of Thoracic and Vascular Surgery, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis Robinson, France.
Chest Surg Clin N Am. 1996 Nov;6(4):819-36.
Acquired, nonmalignant tracheoesophageal fistulae usually result from erosion of the tracheal and esophageal walls by endotracheal or tracheostomy tube cuffs, especially when a rigid nasogastric tube is in place. This has become an infrequent occurrence with the use of high-volume, low-pressure cuffs, but it still represents a life-threatening condition. Spontaneous recovery is exceptional. Most are diagnosed while patients still are mechanically ventilated and, due to the negative effects of positive pressure ventilation on tracheal suture lines, repair should be delayed until patients are weaned. After the patients is weaned from the ventilator, a one-staged anterior approach including esophageal closure, segmental tracheal resection, and primary reconstruction definitely corrects the fistula and removes concurrent tracheal disease and should be preferred to simple division and closure of the fistula.
后天性非恶性气管食管瘘通常是由气管内插管或气管造口管的套囊侵蚀气管壁和食管壁所致，尤其是在放置硬质鼻胃管的情况下。随着大容量、低压套囊的使用，这种情况已不常见，但它仍然是一种危及生命的状况。自发恢复的情况极为罕见。大多数病例是在患者仍接受机械通气时被诊断出来的，由于正压通气对气管缝合线有负面影响，修复手术应推迟到患者脱机后进行。患者脱机后，采用包括食管闭合、节段性气管切除和一期重建的一期前路手术肯定能纠正瘘管，并消除并发的气管疾病，应优先于简单的瘘管分离和闭合术。
