Management of acquired benign tracheoesophageal fistula / 中华胸心血管外科杂志

Objective To explore the treatment of acquired benign tracheoesophageal fistula.Methods Clinical data of 13 cases of acquired benign tracheoesophageal fistula were retrospectively studied and the related literature was reviewed.The physical conditions,locations of fistula and risk factors of the patients were assessed before surgery.A specific surgical protocol was determined for each individual patient using either radical surgery or palliative surgery to repair the fistula.Ten patients underwent radical surgery,including suture closure of the esophageal or tracheal defects only in 7 patients and segmental tracheal reseetion in 3 patients.The remaining 3 patients underwent palliative operation.Results No major complication was observed except pulmonary infectin in 2 patients.No patient died during the perioperative period.All but one patient who treated with mediastinal and neck radiation therapy 4 years ago were able to resume oral food three months after operation.All patients were followed up for 8 months to 73 months[mean (39.6 ± 19.7) months]and no fistulas were occurred in the patients who received a radical surgery.The tracheoesophageal fistula orifices became smaller or closed fairly well in the patients who underwent a palliative surgery.Conclusion Surgery is the treatment of choice for acquired benign tracheoesophageal fistula.Airway and esophagal stent placement is not recommended.Adequate drainage of gastric juice is a crucial step in the management of the condition.

Study on the mode of operation for post-radiotherapy esophageal carcinoma / 中国癌症杂志

Purpose:To discuss which is the better mode of operation for esophageal carcinoma after radiation therapy. Methods:We divided 232 esophageal carcinoma patients into two groups (group A 116 patients and group B 116 patients) random. Operation mode of group A was posterolateral thoracotomy through the bed of sixth rib in right thorax, retrosternal replacement esophagus with stomach and left neck anastomosis or esophagus exteriorization. Correspondingly operation mode of group B was anterolateral thoracotomy through the intercostal space of fourth rib in right thorax, esophageal pouch replacement esophagus with stomach and left neck anastomosis or esophagus exteriorization. We analyzed the resection rate, the mortality rate, the duration of operation, the volume of bleeding and total incidence of complication in each group. Results:The resection rate was 100% in group A and 92.24% in group B ( P 0.05). Conclusions:Operation mode of group A is a better mode of operation for esophageal carcinoma after radiation therapy which is based on the resection rate, which is higher in group A than in group B and total incidence of complication which is lower in group A than in group B.