Case study: tracheoesophageal fistula

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Case introductionPatients, male, 58 years old, in February due to the "lung cancer" at a local hospital for resection of right upper lung. 3

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Case introduction

Patients, male, 58 years old, in February due to the "lung cancer" at a local hospital for resection of right upper lung. 3 days after the operation, the patient appeared to leak after coughing, then the patient after eating food residue in the chest. To be fasting, nasal feeding. About 500ml purulent fluid per day. Before January, the patients with esophageal stent implantation, the patient's chest drainage volume gradually decreased to about 50ml per day, but still purulent liquid. Eating 3 weeks ago, because after eating cough again no diet, and into the stomach to nasal feeding. Patients have been leaking, in order to seek further diagnosis and treatment, outpatient with lung cancer postoperative esophageal tracheal fistula.

Preoperative bronchoscopy:

From here you can see the patients with tracheoesophageal fistula in the left main bronchus (membranous fistula in the carina side, terminating in the distal left main branch), the fistula is about 3cm, and postoperative surgical suture exposure within the lumen, since the fistula can be seen in patients with esophageal stent after entering implants.

Case review

Patients, male, 58 years old, in February due to the "lung cancer" at a local hospital for resection of right upper lung. 3 days after the operation, the patient appeared to leak after coughing, then the patient after eating food residue in the chest. To be fasting, nasal feeding. About 500ml purulent fluid per day. Before January, the patients with esophageal stent implantation, the patient's chest drainage volume gradually decreased to about 50ml per day, but still purulent liquid. Eating 3 weeks ago, because after eating cough again no diet, and into the stomach to nasal feeding. Patients have been leaking, in order to seek further diagnosis and treatment, outpatient with lung cancer postoperative esophageal tracheal fistula.

Preoperative bronchoscopy:

From here you can see the patients with tracheoesophageal fistula in the left main bronchus (membranous fistula in the carina side, terminating in the distal left main branch), the fistula is about 3cm, and postoperative surgical suture exposure within the lumen, since the fistula can be seen in patients with esophageal stent after entering implants.

Treatment: Y type silicone stent implantation

Tracheal endoscopic Y silicone stent implantation: stent distal in trachea and both main bronchi, and completely occlusion of left main bronchus fistula.

2 days after operation, chest CT showed no obvious leakage

Case analysis:

Let's do a paichufa, left main bronchial fistula plugging for this patient is not appropriate, because the fistula from the carina left, left main branch stent and can not achieve good sealing effect, is the ideal type of tracheobronchial stent implantation of Y, in order to achieve full coverage of stent left main bronchial, so as to the effect of blocking the fistula.

A silicone stent can be used in the treatment of tracheobronchial fistula is still controversial. The reason why choose silicone stent, is considering Y metal stent from difficulties and complications of problems.

The patient belongs to the broncho esophageal fistula, and the esophageal stent is still difficult to achieve the effect of plugging. Just because of the current domestic imported silicone stent all, in active exploration. We also refer to the literature reported abroad, found similar to the report of 3 cases in Japan and the United States have successful treatment experience in Baylor College of Medicine. The final selection of the silicone stent. Spike type Y silicone stent (nail protrusion immobilization) in trachea, bronchi within the stent has no spikes, if you choose the appropriate length and larger diameter also can reach the effect of blocking the fistula. In the short term, the patient has a good effect of fistula closure, and further follow-up observation to understand the long-term efficacy.

 

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