Endrédi J, Horváth O P
1st Surgical Department, Medical University of Pécs, Hungary.
Acta Chir Hung. 1997;36(1-4):76-8.
A case of severe stricture and a case of tracheogastric fistula after laryngopharyngo-esophagectomy and pharyngogastrostomy for cervical esophageal cancer are described. Stricture is often seen but tracheogastric fistula is a rare complication, however, both are devastating conditions. According to the literature, the survival rate is poor in both cases. The surgical management demands several principles. Recurrent or metastatic cancer must be ruled out. The patients' general condition and nutritional status must be optimized. Pulmonary infection must be cleared. The surgical management of the stricture was a free jejunal transfer after failed attempts of several dilation procedures. The treatment of tracheogastric fistula was suturing the stomach and covering the trachea with a pedicled left sternocleidomastoideus flap. The survival of the patient treated with free jejunal interposition exceeds 24 month. Unfortunately, the patient with tracheogastric fistula, treated with interpositioned sternocleidomastoideus muscular flap, lived two weeks after this operation. The surgical managements described in this report may provide palliation or definitive treatment for these devastating complications.
本文描述了1例因颈段食管癌行喉咽食管切除术及咽胃吻合术后出现严重狭窄的病例和1例气管胃瘘的病例。狭窄较为常见，但气管胃瘘是一种罕见的并发症，然而，这两种情况都是严重的病症。根据文献报道，这两种情况的生存率都很低。手术治疗需要遵循几个原则。必须排除复发或转移性癌症。必须优化患者的一般状况和营养状况。必须清除肺部感染。对于狭窄，在多次扩张手术失败后采用游离空肠移植进行手术治疗。气管胃瘘的治疗方法是缝合胃，并采用带蒂的左胸锁乳突肌瓣覆盖气管。接受游离空肠移植治疗的患者存活超过了24个月。不幸的是，接受胸锁乳突肌肌瓣移植治疗气管胃瘘的患者在术后仅存活了两周。本报告中描述的手术治疗方法可能为这些严重并发症提供姑息治疗或确定性治疗。
