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目的总结外科治疗食管癌食管支气管瘘的技术特点和经验,探讨安全、有效的治疗方案。方法回顾性总结第四军医大学唐都医院2007年1月至2010年11月收治12例食管癌食管支气管瘘患者的临床资料,男9例,女3例;年龄37～62岁,平均年龄51.24岁。根据不同病情,12例患者分别采取4种手术方式治疗食管支气管瘘(:1)食管部分切除+食管胃隧道式吻合术+肺叶切除术2例;(2)食管部分切除+食管胃器械吻合术+肺叶切除术5例;(3)食管部分切除+结肠代食管术+肺叶切除术4例;(4)食管部分切除+食管胃吻合术+左全肺切除术1例。结果围手术期死亡2例,病死率为16.67%(2/12),其中1例为食管癌侵及左肺下叶支气管,行食管部分切除+食管胃隧道式吻合术+左肺下叶切除术后第4 d死于心力衰竭;另1例为食管癌侵及左肺上叶支气管行食管部分切除+食管胃器械吻合术+左肺上叶切除术后第11 d死于重症感染伴肾功能衰竭。术后并发轻度脓胸4例,总并发症发生率为41.67%(5/12),并发支气管吻合口瘘1例,经抗感染、引流等治疗后愈合出院。随访1个月～3年,死亡1例;其余患者未出现明显并发症,无死亡。结论依据患者的病情,选择个体化手术方式,是临床治疗食管癌食管支气管瘘患者安全有效的治疗方案。
Objective To summarize the technical characteristics and experience of surgical treatment of esophageal bronchial fistula and discuss the safe and effective treatment plan. Methods The clinical data of 12 esophageal cancer patients with esophageal bronchial fistula admitted from Tangdu Hospital, Fourth Military Medical University from January 2007 to November 2010 were retrospectively reviewed. There were 9 males and 3 females, aged 37-62 years, with an average age of 51.24 year old. According to the different conditions, 12 patients were treated by four kinds of surgical treatment of esophageal bronchial fistula (1) esophageal partial resection + esophageal tunnel anastomosis + lobectomy in 2 cases; (2) esophagectomy + esophageal anastomosis + Lobectomy in 5 cases; (3) partial esophagectomy + colon esophagectomy + lobectomy in 4 cases; (4) esophageal resection + esophageal anastomosis + left pneumonectomy in 1 case. Results Perioperative deaths occurred in 2 cases and the case fatality rate was 16.67% (2/12). One case was esophageal carcinoma invading the left lower lobe bronchus, partial esophagectomy + esophagogastric tunnel anastomosis + left lower lobe resection 4 days after operation died of heart failure; the other 1 case of esophageal cancer invasion and left upper lobe bronchial esophageal partial resection + esophageal anastomosis + left lobectomy after 11 d died of severe infection with kidney Functional failure. Four cases were complicated with mild empyema. The total complication rate was 41.67% (5/12). One case was complicated by bronchial anastomotic fistula. The patients were cured by anti-infection and drainage. Followed up for 1 month to 3 years, 1 patient died; other patients did not appear significant complications, no death. Conclusion According to the patient’s condition, the choice of individualized surgical approach is a safe and effective treatment for esophageal cancer patients with esophageal bronchial fistula.