| Objective: Esophagorespiratory fistula is identified by an abnormal connection between the esophagus and the respiratory tract and is a rare clinical disease and refractory disease that is rarely reported in the literature.Typical symptoms in case of Esophagorespiratory fistula are choking following food intake and Patients usually manifested after eating cough and recurrent pneumonia.The life ecpectancy of the patients without proper treatment may be measured in a short period of time due to infection,and the survival time and quality of life of patients is poor.In this study,the clinical data of Esophagorespiratory Fistula patients were nalyzed to understand the disease correctly and comprehensively,improve diagnosis and treatment level,and ameliorate patient prognosis.Methods: General information of 43 cases of Esophagorespiratory fistula Seleted from 2000 to 2015 were retrospectively analyzed,whose diagnosis accorded with definition of Esophagorespiratory fistula in The first hospital affiliated to dalian medical university,including the general information,incidence,past medical history,clinical manifestations,course of disease,auxiliary examination and treatment.All data were statistically processed and analyzed by the SPSS17.0 statistical software and Microsoft Excel processing.Results: Out of 43 cases of Esophagorespiratory fistula in this study,39 were male(90%)and 4 were female(9%),so the ratio of male to female was 9.75:1.The age of onset is from 17 years old to 84 years old,and the average age was 57.6 years old,the median age was 55 years.Age more than 40 years in 41 cases(95%),and the main part of the patients were in 50 ~ 60 years old.The position of fishtula in esophagus: the cervical and upper thoracic segment were 22 cases(51%),middle thoracic segment were 14 cases(32.6%),lower thoracic segment were7 cases of(16.3%).Malignant esophagorespiratory fistula were 40 cases(93%),Benign esophagorespiratory fistula were 3 cases(7%).The characteristics of 40 cases of Malignant esophagorespiratory fistula: esophageal cancer were 30 cases(69%),lung cancer were 7 cases(16%),cardia cancer were 1 case(2%),thyroid cancer were 1 case(2%);fistula time: the leaset time from diagnosis cancer to Esophagorespiratory fistula development were 1 day,the longest time were 2 years,and average time was 9 months,median time was six month.Tumor of the esophagus causes respiratory fistula: direct tumor formation fistula 8 cases(20%);Form a fistula after surgical treatment of 14 cases(35%),including pure surgery treatment of 7 cases(17%);Radiation treatment of 17 cases(42%),including pure radiotherapy in 3 patients(7%);Chemotherapy in 15 cases(37%),pure chemotherapy in 3 patients(15%),esophageal stent in 5 patients(12%),including pure line stents in 3 patients(7%);Two and two or more methods treatment of 16 cases(40%).Major symptoms in these patients were choking following food or water intake in 37 cases(86%),chest pain in 14 cases(32%),cough in 23 cases(53%),expectoration in 26 cases(60%),hemoptysis in 10 cases(23%),and dyspnea in 9 patients(21%),fever in 14 cases(32%).The shortest time from the onset of Symptoms to diagnosis of Esophagorespiratory fistula were 2 hour,the longest time were 45 days,and average time was 17 days,the median time was 10 days.The positive rate of gastrointestinal radiography was 86% cases of,CT positive rate was 36%,the positive rate of endoscopy was 45%.There were differences in positive rate between Gastrointestinal radiography and CT and between Gastrointestinal radiography and endoscopy(p<0.01).The study of 43 patients,including 6 cases of death,the mortality rate was 14% and 4 cases died of severe pulmonary infection.Effect of 28 cases of stent placement of the esophagus,of which 25 cases of one-time stenting,recovered well postoperatively,1 case of postoperative symptoms don't give gastrointestinal nutrition tube,2 cases of postoperative fistula death again.Surgery in 3 cases,1 case of esophageal respiratory tract gastrointestinal anastomosis fistula line established by foreign body,1 case in fistula finds fistula formation of scar excision repair not to continue operation,1 case due to the large tumor can't row stents give gastric fistula treatment,patients recovered well postoperatively,resume eating.Conservative treatment of 11 cases,4 cases died,3 of whom underwent gastrointestinal nutrition tube,2 cases of symptoms,1 case died;5 cases deterioration families give up;3 cases died.Conclusions:1.The morbidity of Esophagorespiratory fistula is not high,and The patients primarily were male in age group of more than 40 years old,50-60 years old is the peak incidence.The disease mainly attacts malignant,especially esophageal cancer is the most common.2.Patients with unexplained recurrent pulmonary infection symptoms should be alert to the occurrence of respiratory fistula of esophagus.3.The tumor surgery,radiotherapy,chemotherapy and stents has all can cause the disease.4.It is more important that timely fistula sealed than treatment of the primary disease After diagnosed Esophagorespiratory fistula,and surgical therapy preferred used to Benign,stent implantation preferred used to malignant can significantly increase improve survival time and quality of life of patients. |
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