食管異物及合并主動脈食管瘺的診斷與治療_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

魏益平 , 陳立如 ,  徐建軍 , 陳向來 , 彭金華 , 王一明 , 喻東亮 , 江涵

南昌大學第二附屬醫院心胸外科，南昌 330006;

Corresponding?author：

徐建軍, Email: xujianjun3526@163.com

Keywords：

食管異物; 主動脈食管瘺; 多層螺旋CT; 雜交技術

DOI：

10.7507/1007-4848.20140159

Video：

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目的探討食管異物所致主動脈食管瘺的診斷及治療方法。方法回顧性分析2004年1月至2012年12月南昌大學第二附屬醫院32例異物性食管損傷患者的診斷和治療經驗。其中男21例、女11例，年齡18～78歲。采用多層螺旋CT（MSCT）及其影像后處理對食管異物病理變化進行準確分級；對主動脈食管瘺的患者采用包括雜交技術（覆膜支架腔內隔絕術＋胸腔鏡縱隔引流術）為主的治療方案，總結MSCT和雜交技術在異物性主動脈食管瘺診療中的應用價值。結果平掃影像診斷與臨床診斷符合率為75%（24/32），影像后處理診斷與臨床診斷符合率為100%（17/17）。MSCT分級所有Ⅰ級、Ⅱ級和Ⅲ級患者均治愈出院，4例Ⅳ級患者采用雜交技術治療；7例Ⅳ級主動脈食管瘺患者中有5例痊愈出院，2例死亡，因開胸行主動脈修補術中死亡1例，開胸行主動脈置換術后24 h內死亡1例。30例痊愈出院患者隨訪6個月，除1例Ⅳ級患者有輕微背痛以外，其他患者無不適。結論 MSCT對食管異物性損傷的準確分級和治療方式選擇均有重要的價值，雜交技術治療異物性主動脈食管瘺具有重要的臨床意義。

Citation： 魏益平, 陳立如, 徐建軍, 陳向來, 彭金華, 王一明, 喻東亮, 江涵. 食管異物及合并主動脈食管瘺的診斷與治療. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 563-566. doi: 10.7507/1007-4848.20140159 Copy

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2.	Lai H, Ge D, Zheng YJ, et al. Surgical management of aortoesop-hageal fistula caused by foreign bodies. Eur J Cardiothorac Surg, 2011, 40 (1):13-16.
3.	昌盛, 程邦昌, 黃杰, 等.胸食管異物損傷病變的分級和外科治療.中華外科雜志, 2006, 44 (6):409-411.
4.	張殿堂, 張榮華, 朱水波, 等.食管異物并主動脈食管瘺的外科治療探討.中華外科雜志, 1996, 34 (10):36-38.
5.	Zhang XL, Liu JJ, Li JJ, et al. Diagnosis and treatment of 32 cases with aortoesophageal fistula due to esophageal foreign body. Laryngoscope, 2011, 121 (2):267-272.
6.	Peng AQ, Li YZ, Xiao Z, et al. Study of clinical treatment of esophageal foreign body-induced esophageal perforation with lethal complications. Eur Arch Otorhinolaryngol, 2012, 269 (9):2027-2036.
7.	時輝, 沈春輝, 梅龍勇, 等.食管異物的外科治療.中國胸心血管外科臨床雜志, 2011, 18 (4):329-331.
8.	Xi EP, Zhu J, Zhu SB, et al. Surgical treatment of aortoesophageal fistula induced by a foreign body in the esophagus:40 years of experience at a single hospital. Surg Endosc, 2013, 27 (9):3412-3416.
9.	Ohta N, Koshiji T, Imamura M, et al. Aortoesophageal fistula caused by foreign body. Jpn J Thorac Cardiovasc Surg, 2000, 48 (3):184-185.
10.	Mirvis SE. Imaging of acute thoracic injury:the Advent of MDCT screening. Semin Ultrasound CT MR, 2005, 26 (5):305-331.
11.	Steenburg SD, Ravenel JG. Acute traumatic thoracic aortic injuries:experience with 64-MDCT. AJR Am J Roentgenol, 2008, 191 (5):1564-1569.
12.	Caruso S, Crino' F, Milazzo M, et al. Thoracic complications follo-wing lung transplantation:64-MDCT findings. Clin Transplant, 2011, 25 (5):673-684.
13.	Kikuchi K, Tsurumaru D, Hiraka K, et al. Unusual presentation of an esophageal foreign body granuloma caused by a fish bone:usefulness of multidetector computed tomography. Jpn J Radiol, 2011, 29 (1):63-66.
14.	Kelly SL, Peters P, Ogg MJ, et al. Successful management of an aortoesophageal fistula caused by a fish bone--case report and review of literature. J Cardiothorac surg, 2009, 8 (4):21.
15.	Chen XD, Li JW, Chen J, et al. A combined minimally invasive approach for the treatment of aortoesophageal fistula caused by the ingestion of a chicken bone:case report and literature review. Clinics (Sao Paulo), 2012, 67 (2):195-197.

1. Nandi P, Ong GB. Foreign body in the oesophagus:review of 2394 cases. Br J Surg, 1978, 65 (1):5-9.
2. Lai H, Ge D, Zheng YJ, et al. Surgical management of aortoesop-hageal fistula caused by foreign bodies. Eur J Cardiothorac Surg, 2011, 40 (1):13-16.
3. 昌盛, 程邦昌, 黃杰, 等.胸食管異物損傷病變的分級和外科治療.中華外科雜志, 2006, 44 (6):409-411.
4. 張殿堂, 張榮華, 朱水波, 等.食管異物并主動脈食管瘺的外科治療探討.中華外科雜志, 1996, 34 (10):36-38.
5. Zhang XL, Liu JJ, Li JJ, et al. Diagnosis and treatment of 32 cases with aortoesophageal fistula due to esophageal foreign body. Laryngoscope, 2011, 121 (2):267-272.
6. Peng AQ, Li YZ, Xiao Z, et al. Study of clinical treatment of esophageal foreign body-induced esophageal perforation with lethal complications. Eur Arch Otorhinolaryngol, 2012, 269 (9):2027-2036.
7. 時輝, 沈春輝, 梅龍勇, 等.食管異物的外科治療.中國胸心血管外科臨床雜志, 2011, 18 (4):329-331.
8. Xi EP, Zhu J, Zhu SB, et al. Surgical treatment of aortoesophageal fistula induced by a foreign body in the esophagus:40 years of experience at a single hospital. Surg Endosc, 2013, 27 (9):3412-3416.
9. Ohta N, Koshiji T, Imamura M, et al. Aortoesophageal fistula caused by foreign body. Jpn J Thorac Cardiovasc Surg, 2000, 48 (3):184-185.
10. Mirvis SE. Imaging of acute thoracic injury:the Advent of MDCT screening. Semin Ultrasound CT MR, 2005, 26 (5):305-331.
11. Steenburg SD, Ravenel JG. Acute traumatic thoracic aortic injuries:experience with 64-MDCT. AJR Am J Roentgenol, 2008, 191 (5):1564-1569.
12. Caruso S, Crino' F, Milazzo M, et al. Thoracic complications follo-wing lung transplantation:64-MDCT findings. Clin Transplant, 2011, 25 (5):673-684.
13. Kikuchi K, Tsurumaru D, Hiraka K, et al. Unusual presentation of an esophageal foreign body granuloma caused by a fish bone:usefulness of multidetector computed tomography. Jpn J Radiol, 2011, 29 (1):63-66.
14. Kelly SL, Peters P, Ogg MJ, et al. Successful management of an aortoesophageal fistula caused by a fish bone--case report and review of literature. J Cardiothorac surg, 2009, 8 (4):21.
15. Chen XD, Li JW, Chen J, et al. A combined minimally invasive approach for the treatment of aortoesophageal fistula caused by the ingestion of a chicken bone:case report and literature review. Clinics (Sao Paulo), 2012, 67 (2):195-197.

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