食管异物及合并主动脉食管瘘的诊断与治疗_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

魏益平 , 陈立如 ,  徐建军 , 陈向来 , 彭金华 , 王一明 , 喻东亮 , 江涵

南昌大学第二附属医院心胸外科，南昌 330006;

Corresponding author：

徐建军, Email: xujianjun3526@163.com

Keywords：

食管异物; 主动脉食管瘘; 多层螺旋CT; 杂交技术

DOI：

10.7507/1007-4848.20140159

Video：

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目的探讨食管异物所致主动脉食管瘘的诊断及治疗方法。方法回顾性分析2004年1月至2012年12月南昌大学第二附属医院32例异物性食管损伤患者的诊断和治疗经验。其中男21例、女11例，年龄18～78岁。采用多层螺旋CT（MSCT）及其影像后处理对食管异物病理变化进行准确分级；对主动脉食管瘘的患者采用包括杂交技术（覆膜支架腔内隔绝术＋胸腔镜纵隔引流术）为主的治疗方案，总结MSCT和杂交技术在异物性主动脉食管瘘诊疗中的应用价值。结果平扫影像诊断与临床诊断符合率为75%（24/32），影像后处理诊断与临床诊断符合率为100%（17/17）。MSCT分级所有Ⅰ级、Ⅱ级和Ⅲ级患者均治愈出院，4例Ⅳ级患者采用杂交技术治疗；7例Ⅳ级主动脉食管瘘患者中有5例痊愈出院，2例死亡，因开胸行主动脉修补术中死亡1例，开胸行主动脉置换术后24 h内死亡1例。30例痊愈出院患者随访6个月，除1例Ⅳ级患者有轻微背痛以外，其他患者无不适。结论 MSCT对食管异物性损伤的准确分级和治疗方式选择均有重要的价值，杂交技术治疗异物性主动脉食管瘘具有重要的临床意义。

Citation： 魏益平, 陈立如, 徐建军, 陈向来, 彭金华, 王一明, 喻东亮, 江涵. 食管异物及合并主动脉食管瘘的诊断与治疗. 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, 黄杰, 等.胸食管异物损伤病变的分级和外科治疗.中华外科杂志, 2006, 44 (6):409-411.
4.	张殿堂, 张荣华, 朱水波, 等.食管异物并主动脉食管瘘的外科治疗探讨.中华外科杂志, 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.	时辉, 沈春辉, 梅龙勇, 等.食管异物的外科治疗.中国胸心血管外科临床杂志, 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, 黄杰, 等.胸食管异物损伤病变的分级和外科治疗.中华外科杂志, 2006, 44 (6):409-411.
4. 张殿堂, 张荣华, 朱水波, 等.食管异物并主动脉食管瘘的外科治疗探讨.中华外科杂志, 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. 时辉, 沈春辉, 梅龙勇, 等.食管异物的外科治疗.中国胸心血管外科临床杂志, 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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