PDF(Pubmed)
Abstract：
An esophagobronchial fistula, an abnormal passageway formed between the esophagus and bronchus, can cause severe respiratory symptoms. This fistula is a complication that can occur during chemoradiotherapy for esophageal and lung cancers; however, to our knowledge, no esophagobronchial fistulas during preoperative chemotherapy for lung cancer have been reported. The patient was a 55-year-old man whose chest computed tomography (CT) revealed a mass on the dorsal bronchus and right side of the esophagus. A transesophageal needle biopsy confirmed the diagnosis of lung adenocarcinoma, and preoperative chemotherapy, which included pembrolizumab, was administered. One week after the first course of chemotherapy, the patient developed a severe cough after drinking water. Chest CT revealed an esophagobronchial fistula, which prompted the discontinuation of the preoperative chemotherapy. Subsequent conservative treatment resulted in no improvement, and the patient was referred to our department. One month thereafter, a two-stage reconstruction of the esophagus was performed via the posterior sternal route. The resected specimen showed no residual tumor in the lungs, and the treatment was determined to result in a complete pathological response. The patient is currently undergoing maintenance therapy with pembrolizumab as a single agent. This is a rare case of esophagobronchial fistula identified during preoperative chemotherapy that included pembrolizumab for lung cancer. In addition to suturing the fistula, filling it with a distal hyoid valve was effective in treating the esophagobronchial fistula.
摘要：
食管支气管瘘,食管和支气管之间形成的异常通道，会导致严重的呼吸道症状。这种瘘管是食管癌和肺癌放化疗期间可能发生的并发症；然而，根据我们的知识，在肺癌术前化疗期间没有食管支气管瘘的报道。患者是一名55岁的男性，其胸部计算机断层扫描（CT）显示背侧支气管和食道右侧有肿块。经食管穿刺活检证实诊断为肺腺癌，术前化疗,其中包括派姆单抗，被管理。第一个疗程化疗后一周，病人喝水后出现严重咳嗽。胸部CT显示食管支气管瘘,这促使术前化疗停止。随后的保守治疗没有改善，病人被转诊到我们部门.一个月后,通过胸骨后路进行了食管的两阶段重建。切除的标本显示肺部没有残留肿瘤，并且确定治疗导致完全的病理反应。患者目前正在接受使用派姆单抗作为单一药剂的维持治疗。这是术前化疗期间发现的罕见食管支气管瘘病例，其中包括肺癌的派姆单抗。除了缝合瘘管,用舌骨远端瓣膜填充可有效治疗食管支气管瘘。
