We reported a patient intubated for more than 30 d following brain injury, transferred to our department with tracheocutaneous fistula and a 2 cm fistula between the trachea and the esophagus. We performed tracheal resection and esophageal closure with a latissimus dorsi myocutaneous flap interposed between suture lines. The patient continued mechanical ventilation after surgery and the tracheotomy was achieved 14 d after the beginning of surgical treatment. The patient was started oral feeding and discharged on the 10 d after tracheotomy and referred to a neuromotor recovery clinic for treatment of post-traumatic sequelae.
Tracheoesophageal fistula (TEF) is a disease characterized by an abnormal connection between the trachea and esophagus. Benign TEF often results from damage induced by tracheal intubation, primarily presenting as exacerbated cough during swallowing, which can be life-threatening in severe cases. However, there is no unified standard for the surgical treatment of TEF. Currently, the choice of surgical method mainly depends on the location, size, and condition of the surrounding trachea. For small to moderate TEFs, tracheal segmental resection and reconstruction is a classic surgical approach. For larger, complex, and refractory TEFs, musculocutaneous flap repair is an ideal option. This article reviews the application of several common musculocutaneous flaps, including the sternocleidomastoid, pectoralis major, and latissimus dorsi, in the repair of benign TEFs, aiming to provide a reference for the clinical diagnosis and treatment of this disease.
Objective To investigate the application value of spiral CT postprocessing technique in the airway stent implantation technology. Methods Twenty-three patients with malignant airway stenosis or malignant tracheoesophageal fistula who needed the treatment of airway stent implantation from May 2012 to April 2016 were collected, including 19 males and 4 females with an average age of (61.6±10.0) years. Bronchoscopy and spiral CT with three-dimensional airway reconstruction were proceeded for the same patients before and after stent implantation, and the relevant data about narrow airway was measured by volume rendering, multiplanar reformation (MPR) and CT virtual endoscopy (CTVE) in a variety of ways, to confirm the location and size of narrow airway and fistulas, the degree and length of airway stenosis, as well as the distal end of the situation, and evaluate the patency of airway, the position and shape of stents, adjacent airway and complications after stenting. The positive forecast outcomes of the two inspections wascompared. Results Airway stents were placed successfully according to the data from the spiral CT airway three-dimensional reconstruction. Thirty stents were implantated in the 23 patients, including 21 column-type stents, 3 L-type stents, and 6 Y-type stents. All stents stayed in situ, with patency and no deformation.The fistulas were closed and the airways were reopened. Symptoms of cough after eating and drinking and dyspnea were relieved. The positive rates of bronchoscopy and CT examination on diagnosis of airway stenosis were both 100% (23/23). Complications: MRP showed tumor growth leading to stenosis again in 3 patients, and CTVE displayed mucous congestion in 2 patients. Conclusions The technique of 64-layer spiral CT postprocessing technique can measure the relate data of airway stricture or fistulas as a kind of convenient, quick, accurate, and noninvasive method in patients with malignant airway stenosis or tracheoesophageal fistula who need the treatment of airway stenting. It is of high reference value both to airway stent implanting and postoperative observation, and is worthy of application.
Objective To evaluate the clinical efficacy of fistula repair by stapler technique in patients with cervical tracheoesophageal fistula. Methods Retrospective analysis of 8 patients with cervical tracheoesophageal fistula who accepted operative treatment in the Department of Thoracic Surgery, Lanzhou University Second Hospital from October 2014 to October 2016 was conducted. There were 5 males and 3 females at a mean age of 46.4±13.9 years ranging from 23 to 67 years. The fistula was induced by tracheal intubation in 4 patients, by esophageal foreign bodies in 2, by tracheal stent in 1 and by esophageal diverticulum in 1. The fistula was closed by stapler technique. The surgical effects were evaluated through Karnofsky performance score (KPS), image assessment, patient satisfaction score and assessment of improvement in feeding-induced bucking. Results The operations were performed successfully with time of 117.5±6.6 min and intraoperative blood loss of 60.0±7.0 ml. After the operations, the patients did not suffer incision bleeding and infection, hoarseness, dyspnea, drinking-induced bucking, fistula relapse, tracheoesophageal stenosis or any other complications, and no death occurred during the perioperative period. The chest X-ray test was performed 1 week later showed that the pulmonary infection disappeared, and only 1 patient suffered from esophageal stenosis 1 year later. The postoperative KPS score was 90.0±7.0 points, which significantly improved in contrast to preoperation (P<0.01). Postoperative pulmonary infection area reduced significantly (P<0.05), tracheoesophageal fistula disappeared, postoperative patients satisfaction rate was 90%, and assessment of feeding-induced bucking was excellent. Conclusion Using stapler technique to repair cervical tracheoesophageal fistula is safe, easy and useful, with less operation time and postoperative complications.
Abstract： Objective To investigate the cause and treatment of iatrogenic tracheobronchoesophageal fistula and provide experiences for clinic treatment. Methods Between January 1995 to December 2008, 21 patients with tracheobronchoesophageal fistula were treated in Shanghai Chest Hospital and Shanghai 6th Hospital. Among them, iatrogenic fistula happened in 12 patients including 8 males and 4 females whose age ranged from 35 to 74 years old with an average age of 47. Fistula developed 21 d to 5 years after the treatment of the primary diseases which were mainly tumors. Two of them developed tracheoesophageal fistula, 10 bronchoesophageal fistula; 6 right bronchoesophageal fistula, and 4 left bronchoesophageal fistula. Fistula excision and surgical repair of the tracheobronchoesophageal fistula were performed on 2 patients; Lung lobectomy and repair of the esophageal fistula were performed on 5 patients; Tracheal fistula repair and pneumonectomy with reconstruction of the digestive tract were done on the rest 5 patients. Results No operative death occurred. Postoperative complications in 2 cases were cured without recurrence. In the 1year followup to all the 12 patients, no recurrence of fistula occurred. Conclusion Iatrogenic tracheobronchoesophageal fistula is a complex and severe disease for which surgery is the only best treatment.