Grillo H C, Moncure A C, McEnany M T
Ann Thorac Surg. 1976 Aug;22(2):112-9. doi: 10.1016/s0003-4975(10)63971-9.
Benign acquired tracheoesophageal fistula is uncommon. Erosin of the membranous wall of the trachea and the anterior esophageal wall by the high-pressure cuff on a tracheostomy tube, often against the anvil of a nasogastric tube, may produce such fistulas. Techniques for closure have included patching the tracheal defect with muscle and, often, multiple staged procedures, planned or unplanned. Since any cuff lesion severe enough to cause a fistula necessarily damages the trachea circumferentially at the same level, definitive correction must include circumferential tracheal resection as well as closure of the fitstula. Five patients with tracheoesophageal fistula due to cuff perforation had repair by such a single-stage procedure. Through an anterior approach the involved trachea was resected, primary anastomosis was done, and the esophagus was closed in layers. In 3 of these 5 patients muscle was interposed for added security. One patient had undergone a prior attempt at repair elsewhere. One required a second resection of trachea for subsequent stomal stenosis. Repair in 2 additional patients with fistulas of complex origin related to direct trauma, sepsis, and foreign body involved adaptation of the basic technique to the special problem; 1 of these procedures was necessarily staged. Results in all 7 patients have been good.
良性后天性气管食管瘘并不常见。气管造口管上的高压套囊对气管膜壁和食管前壁造成侵蚀，通常是抵住鼻胃管的砧座，可能会产生此类瘘管。闭合瘘管的技术包括用肌肉修补气管缺损，而且通常需要多次分期手术，无论是计划内的还是非计划内的。由于任何严重到足以导致瘘管的套囊损伤必然会在同一水平周向损伤气管，因此确定性矫正必须包括周向气管切除以及瘘管闭合。5例因套囊穿孔导致气管食管瘘的患者通过这种一期手术进行了修复。通过前路切除受累气管，进行一期吻合，并分层关闭食管。这5例患者中有3例置入肌肉以增强安全性。1例患者之前在其他地方尝试过修复。1例患者因随后的造口狭窄需要再次切除气管。另外2例因直接创伤、败血症和异物导致的复杂来源瘘管患者的修复，需要将基本技术应用于特殊问题；其中1例手术必然是分期进行的。所有7例患者的结果都很好。
