Study On The Clinical Curative Effect Of Different Methods In The Treatment Of Acquired Tracheal-bronchoesophageal Fistula

Objective:To summarize the clinical characteristics of acquired tracheal-bronchoesophageal fistula and compare the clinical efficacy of different methods in the treatment of ATEF.,to explore the application value of different treatments.Methods:A retrospective study was conducted to analyze the clinical diagnosis and treatment data of 43 cases of ATEF admitted from January 2009 to January 2019,which were divided into three groups according to the treatment methods,namely 9 cases in the surgical group,29 cases in the interventional treatment group and 5 cases in the conservative treatment group.The clinical characteristics of ATEF were summarized by sorting out the etiology,fistula size and location,clinical symptoms and treatment process of each group.The success rate,mortality rate and remission rate of clinical symptoms in different treatment groups were compared to evaluate the short-term efficacy.Observation and comparison of fistula healing/plugging effect,major complications,and survival in different treatment groups during the follow-up period to evaluate the medium and long-term efficacy.All data were analyzed by SPSS 23.0 statistical software,and T test was used to compare the data before and after treatment in the group,the k-m method was used to draw the survival curve,and the inter-group survival analysis was tested by log-rank test.The difference of P<0.05 was statistically significant.Results:the 43 cases in the whole group,31 cases(72.1%)were tracheoesophageal fistula,12cases(27.9%)were bronchoesophageal fistula,and 17cases(39.5%)were benign ATEF according to the nature of onset.Iatrogenic injury was the most common cause of benign ATEF,26cases(60.5%)were malignant ATEF,and esophageal cancer was the most common cause of malignant ATEF.Fistula is located in the middle esophagus 29 cases(67.4%)and trachea ? district 22 cases(51.1%),the most common esophageal fistula opening an average of 9.1 ±3.9 mm,8.7±3.9 mm,tracheal fistula of esophagus and trachea fistula size differences,no statistical significance(P>0.05).In the surgical operation group,9 patients were operated by 5 surgical methods,and the main postoperative complication was pulmonary infection(44.4%).One patient underwent secondary thoracotomy without death,and all of them were discharged after treatment.A total of 22 cases(75.9%),17 cases(58.6%)and 10 cases(34.5%)were implanted with esophageal covered stents in the interventional treatment group,with a technical success rate of 96.6%.There were no serious complications during the operation.The postoperative complications were mainly chest discomfort in 22 cases(75.9%),sputum retention in 18 cases(62.1%),and stent displacement in 3 cases(10.3%).All 5 patients in the conservative treatment group were treated with conventional treatment.After treatment,both the respiratory distress index(mMRC)and the behavioral status score(ECOG)were significantly improved in the surgical and interventional treatment groups,with statistically significant differences(P<0.001),while the remission was not significant in the conservative treatment group,with no statistically significant differences(P>0.05).To evaluate the fistula healing/blocking effect within 1 to 2 months after the operation,the surgical healing rate was the highest(CR 88.9%),the interventional treatment group had the highest healing rate(CR 13.8%),the clinical complete response rate(cCR)was 70.0%,the conservative treatment had no CR and cCR,and the ineffective(NR)was 40%.In the surgical group,no serious complications occurred after discharge,4 cases died due to tumor progression,and 5 cases survived till now,with a median survival time of 42 months.Intervention groups etiology malignant in 22 cases(75.9%),7 cases(24.1%),benign causes group support related complications,more serious causes group of the most common complications for continuous chest discomfort,followed by the secretion retention and deadly big haemoptysis/hematemesis,admission line bracket adjust/take/reattachment rate is higher,the average readmission 2.3±0.9 times,22 cases of follow-up all died,the cause of death mainly include tumor progression,lung infection,haemoptysis/hematemesis and suffocation,granulation hyperplasia induced by benign disease group for the longest complications,rate is as high as 57.1%,the average readmission was 4.5±2.9 times,Five of them died from lung infection or tumor progression,and two died,with a median survival time of 4.5 months.Among the 5 patients in the conservative treatment group,2 died of pulmonary infection in hospital and 3 died of pulmonary infection after discharge,with a median survival time of 0.8 months.Log-rank test was used to compare the survival rate of the three groups,and the difference was statistically significant(P<0.001).In addition,the 1-year,2-year and 3-year survival rates of the surgical benign group were higher than those of the interventional benign group and those of the interventional malignant group,with a median survival time of 3.5±0.5 months.Conclusion:Tracheoesophageal fistula is the most common type of ATEF,esophageal cancer and iatrogenic injury is the most common cause of fistula is located in the middle esophagus and trachea III area is the most common.Surgery and interventional therapy is safe and effective in the short and medium term of ATEF treatment.Surgical operation is the first choice for benign ATEF,while interventional therapy is the first choice for malignant ATEF.