Hariya A, Makuuchi H, Naruse Y, Kobayashi T, Ogata K, Tsurumaru M
Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, Saitama, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Aug;46(8):777-80. doi: 10.1007/BF03217820.
Aorto-esophageal fistula due to ruptured thoracic aortic aneurysm is very rare but is associated with extremely high mortality. An 81-year-old woman was admitted due to repeated hematemesis. Endoscopic examination revealed ulceration with blood clot on the mid-esophagus and compression of an extra-esophageal mass. The thoracic CT scan revealed an aorto-esophageal fistula due to a ruptured descending thoracic aortic aneurysm. Surgery was performed on April 3, 1996. We report an aorto-esophageal fistula managed successfully in one stage by resection and replacement of the aortic aneurysm with a prosthetic graft and total esophageal resection. The esophagus was reconstructed using orthotopic gastric interposition with omentopexy around the prosthetic aortic graft. The postoperative course was uneventful and there have been no signs of mediastinal sepsis, graft infection or pyothorax 12 months postoperatively. We suggest that the resection of both the aneurysm and the esophagus as well as the immediate reconstruction of the esophagus by orthotopic gastric interposition to obliterate the retrosternal space are important technique in the management of intrathoracic infections.
因胸主动脉瘤破裂导致的主动脉食管瘘极为罕见，但死亡率极高。一名81岁女性因反复呕血入院。内镜检查发现食管中段有溃疡伴血凝块，且有食管外肿块压迫。胸部CT扫描显示因降主动脉瘤破裂导致的主动脉食管瘘。于1996年4月3日进行了手术。我们报告了一例通过切除并用人造血管置换主动脉瘤以及全食管切除，成功一期治疗主动脉食管瘘的病例。食管采用原位胃代食管术重建，并在人造主动脉移植物周围行网膜固定术。术后过程顺利，术后12个月无纵隔感染、移植物感染或脓胸迹象。我们认为，切除动脉瘤和食管，以及通过原位胃代食管术立即重建食管以消除胸骨后间隙，是治疗胸内感染的重要技术。
