Bartels H E, Stein H J, Siewert J R
Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technischen Universität München, Germany.
Br J Surg. 1998 Mar;85(3):403-6. doi: 10.1046/j.1365-2168.1998.00579.x.
Lesions of the trachea or main-stem bronchi with air leakage are a grave complication of oesophagectomy.
Prevalence, predisposing factors and outcome of non-malignant lesions of the trachea or main-stem bronchi were analysed retrospectively in a consecutive series of 785 patients who had oesophagectomy for oesophageal cancer.
Overall 31 of 785 patients developed a tracheobronchial fistula 1-30 days after oesophagectomy. Based on the location of the lesions and clinical circumstances, the tracheobronchial fistulas were thought to be due to surgical injury (four patients), cuff pressure of the tracheostomy tube (two), local peritracheal infection resulting from a cervical anastomotic leak (seven) or 'ischaemia' after extensive peritracheal dissection (18). On multivariate analysis, transthoracic en bloc resection (P < 0.01) and preoperative radiochemotherapy for locally advanced tumours located at or above the level of the tracheal bifurcation (P < 0.01) predisposed to this complication.
Non-malignant tracheobronchial lesions are a serious complication of transthoracic oesophagectomy with extensive lymph node dissection, particularly in patients undergoing preoperative radiochemotherapy for locally advanced tumours.
气管或主支气管损伤伴漏气是食管癌切除术后的严重并发症。
对连续785例行食管癌切除术的患者进行回顾性分析，以探讨气管或主支气管非恶性病变的发生率、易感因素及预后。
785例患者中，有31例在食管癌切除术后1至30天发生气管支气管瘘。根据病变部位及临床情况，气管支气管瘘被认为是由手术损伤（4例）、气管造口管套囊压力（2例）、颈部吻合口漏引起的局部气管周围感染（7例）或广泛气管周围剥离后的“缺血”（18例）所致。多因素分析显示，经胸整块切除（P < 0.01）及对位于气管隆突水平或以上的局部晚期肿瘤进行术前放化疗（P < 0.01）易导致该并发症。
非恶性气管支气管病变是广泛淋巴结清扫的经胸食管癌切除术的严重并发症，尤其是对局部晚期肿瘤进行术前放化疗的患者。
