摘要
目的探讨主动脉一食管瘘的临床特点、诊断要点和腔内治疗方法的选择及预后，提高对该疾病的认识。方法回顾性分析2010年10月至2016年7月收治的3例主动脉一食管瘘患者临床症状、体征、腔内治疗的过程及随访结果，并复习相关文献。结果患者男2例，女1例；年龄64-70岁。胸外伤、主动脉假性动脉瘤和食管异物各1例。3例均有胸痛、呕血和发热，其中前哨性出血2例，突发大量呕血1例。均经胃镜或主动脉CTA检查明确诊断。经主动脉腔内覆膜支架置入术治疗，急性期效果良好，无明显近期并发症，再发出血时间为35—85天。2例术后死于再发多次呕血，其中1例再次行主动脉腔内覆膜支架置入术治疗无效；1例死于开放手术后多器官功能衰竭。结论腔内治疗方法对于主动脉一食管瘘的短期效果尚可以接受，但远期效果不满意，仅作为一般情况较差患者开放手术前的过渡治疗方法，待病情稳定后，最好于1周内联合开放手术。
Objective To investigate the clinical features, essentials of diagnosis, selection of endovascular treatment and prognosis of aorto-esophageal fistula（ AEF）. To improve the understanding of the disease. Methods 3 patients with AEF from October 2010 to July 2016 in Changhai Hospital, including clinical symptoms and signs, endovascular treatment process and follow-up results, and review the relevant literature. Results Two of the 3 patients are men, and another is a woman. Aged 64 - 70 years. The causes of AEF are chest trauma, thoracic aorta pseudoaneurysms and foreign body ingestion, respectively. All the 3 patients had chest pain, hematemesis, and fever. Two of them showed sentinel hemorrhage and another showed a sudden massive hematcmesis. Upper gastrointestinal endoscopy or computed tomographic angiography （ CTA ） confirmed the diagnosis in all patients. They all underwent thoracic endovascular aortic repair（ TEVAR）. The effect was good in acute phase. It didn＇ t have any significant short-term complications. Re-bleeding time was 35 days to 85 days. Two patients died of recurrent severe hemorrhage post operation, and one of them had received TEVAR again but not it was ineffective. Another died of multiple organ failure after open surgery. Conclusion Since it showed the short-term effect but not the long-term effect, TEVAR can only be applied as a temporary remedy to the patients in poor conditions and be substituted by the open surgery when the patients were in better conditions.
出处
《中华胸心血管外科杂志》
CSCD
2017年第11期658-662,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
国家自然科学基金青年项目（81200225）,第二军医大学青年基金（2010QN11）,长海医院“1255”科研探索项目（CH125541200）,长海医院机动卫勤分队军事课题立项（WQ2015015）
关键词
主动脉食管瘘
治疗
腔内
Aorto-esophageaX fistula Therapy Endovascular
