背景:获得性非恶性气管食管瘘(TEF)是一种罕见的气管和食管之间的病理连接,主要由医源性损伤引起。袖口相关损伤导致气管食管壁压力性坏死,通常是由于管子的过度膨胀。
方法:一名机械通气3个月的29岁男性在断奶后出现TEF。病人有严重的败血症,右下叶肺炎,和肺炎旁积液需要多学科方法管理。采用了术前措施,包括控制败血症,营养支持,胃减压,肺物理治疗,将袖带放置在瘘管远端,从通风中断奶。我们使用外侧入路用插入绑带肌皮瓣进行了一期TEF修复。
结论:手术方式很大程度上取决于瘘管的位置,尺寸,并伴有气管狭窄.大的TEF或气管狭窄通过分段气管切除和吻合来修复。小TEF和正常气管直接闭合气管和食管缺损,可以通过外侧或前宫颈切开术进行。
结论:这个案例强调了多学科方法的重要性,术前管理,和细致的手术技术在获得性TEF的管理中。
BACKGROUND: Acquired non-malignant tracheoesophageal fistula (TEF) is a rare pathological connection between the trachea and esophagus caused primarily by iatrogenic injuries. Cuff-related injury causes pressure necrosis of the tracheoesophageal walls, often due to the overinflation of tubes.
METHODS: A 29-year-old male who was mechanically ventilated for 3 months developed TEF after weaning from ventilation. The patient had severe sepsis, right lower lobe pneumonia, and parapneumonic effusion requiring multidisciplinary approach management. Preoperative measures were applied, including control of sepsis, nutritional support, stomach decompression, lung physiotherapy, placement of the cuff distal to the fistula, and weaning from ventilation. We performed a one-stage TEF repair with an interposition strap muscle flap using the lateral approach.
CONCLUSIONS: The surgical approach greatly depends on the fistula location, size, and concomitant tracheal stenosis. Large TEFs or tracheal stenosis are repaired with segmental tracheal resection and anastomosis. Small TEFs and a normal trachea are repaired with direct closure of tracheal and esophageal defects, which can be performed through lateral or anterior cervicotomy.
CONCLUSIONS: This
case emphasizes the importance of a multidisciplinary approach, preoperative management, and meticulous surgical technique in the management of acquired TEF.