Kojima M, Tachimori Y, Kato H, Kondo H, Watanabe H
Department of Surgery, National Cancer Center Central Hospital, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 May;44(5):668-72.
A successful case of surgical treatment for a bronchogastric tube fistula after resection for esophageal cancer are reported herein. The patient was a 67-year-old male who had undergone blunt total esophagectomy with reconstruction of a whole gastric tube pulled up through the posterior mediastinum and laryngopharyngectomy with a permanent end-tracheostomy in February, 1983. After the operation, he was irradiated prophylactically to the both neck and upper mediastinum with a total dose of 50 Gy. He showed no sign of recurrence. But 11 years after the operation, he complained excretion of food from his tracheostomy. Endoscopical examination on admission revealed an ulcer in the anterior wall of the reconstructed gastric tube penetrating to the right main bronchus. He was treated conservatively, but endoscopy didn't reveal the ulcer in healing. So we performed an operation. At first the gastric tube and the right main bronchus were divided. Then we attempted to close each fistula. We could suture the gastric tube wall tightly. The membranous wall of bronchus around the fistula was weak, but we could close that fistula without air leak by using the azygos vein flap. His postoperative course was uneventful. We consider that postoperative irradiation, administration of antibiotics, and bile reflux etc. might play significant role in development of the penetrating ulcer.
本文报道了一例食管癌切除术后支气管胃瘘的成功手术治疗病例。患者为67岁男性，1983年2月接受了钝性全食管切除术，通过后纵隔将整个胃管上提进行重建，并进行了喉咽切除术及永久性气管造口术。术后，对其颈部和上纵隔进行了预防性放疗，总剂量为50 Gy。他没有复发迹象。但术后11年，他出现经气管造口排出食物的情况。入院时内镜检查发现重建胃管前壁有一溃疡，已穿透至右主支气管。他接受了保守治疗，但内镜检查显示溃疡未愈合。于是我们进行了手术。首先将胃管与右主支气管分离。然后试图封闭每个瘘口。我们能够紧密缝合胃管壁。瘘口周围支气管的膜性壁较薄弱，但我们通过使用奇静脉瓣封闭了该瘘口，且无漏气。他术后恢复顺利。我们认为术后放疗、抗生素的使用以及胆汁反流等可能在穿透性溃疡的发生中起重要作用。
