一家三级胃食管外科中心连续收治的一系列消化道瘘患者的管理和治疗效果

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS ACS Applied Bio Materials Pub Date : 2023-12-15 DOI:10.1093/dote/doad068
Fahad Murad, Fredrik Klevebro, Gert Henriksson, Ioannis Rouvelas, Mats Lindblad, Magnus Nilsson
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引用次数: 0

摘要

摘要 消化道瘘(ADF)是指上消化道与气道之间的病理连接。ADF 与高发病率和高死亡率有关,其治疗通常比较复杂。根据前瞻性收集的管理数据和回顾性收集的电子病历数据,对一家三级食管外科中心 2004-2022 年收治的所有 ADF 患者进行了一项队列研究。研究评估了三种不同类型的 ADF 患者的人口统计学特征、表现状态、合并症、瘘管特征、管理以及发病率和死亡率方面的结果:(i) 肿瘤过度生长相关,(ii) 各种良性病因,(iii) 食管切除术后。研究共纳入 61 例 ADF 患者,其中 33 例(54.1%)与肿瘤过度生长有关,6 例(9.8%)为良性病因,22 例(36.1%)为食道切除术后病因。在食管切除术后组中,22 位患者中有 15 位(68.2%)在确诊 ADF 之前已被诊断为吻合口漏。61名患者中有59名(96.7%)使用了自膨胀金属支架(SEMS)进行临时瘘管封堵,其中大多数患者在消化道和气道都使用了支架。在 59 名患者中,有 47 名(79.7%)成功使用支架临时封堵了瘘管,并顺利出院。16名患者(26.2%)接受了ADF最终修复手术,其中1名患者(6.3%)在90天内死亡,15名患者的瘘管被永久封堵,可以出院回家。ADF 是一种复杂的疾病,死亡率很高,通常需要多种先进的干预措施。SEMS 可用于气道,同时也可用于消化道,以暂时封闭 ADF,作为最终手术修复的桥梁。
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Management and outcomes in a consecutive series of patients with aero-digestive fistula at a tertiary gastro-esophageal surgery center
Summary Aerodigestive fistula (ADF) is defined as a pathological connection between the upper digestive tract and the airway. ADF is associated with high morbidity and mortality and management is often complex. A cohort study including all patients admitted with ADF 2004–2022 at a single tertiary esophageal surgery center was performed based on prospectively collected administrative data and retrospectively collected electronic patient chart data,. Patient demographics, performance status, comorbidity, fistula characteristics, management, and outcomes in terms of morbidity and mortality were assessed in patients with ADF of three distinct types: (i) tumor overgrowth-related, (ii) various benign etiologies, and (iii) post-esophagectomy. Sixty-one patients with ADF were included in the study, 33 (54.1%) tumor overgrowth-related, six (9.8%) benign and 22 (36.1%) post-esophagectomy. In the post-esophagectomy group 15 out of 22 (68.2%) patients were diagnosed with anastomotic leakage prior to ADF diagnosis. Self-expandable metallic stents (SEMS) were used for temporary fistula sealing in 59 out of 61 (96.7%) patients, of which most received stents in both the digestive tract and airway. Temporary fistula sealing with stents was successful enabling discharge from hospital in 47 out of 59 (79.7%) patients. Definitive ADF repair was performed in 16 (26.2%) patients, of which one (6.3%) died within 90-days and 15 could be discharged home with permanently sealed fistulas. ADF is a complex condition associated with high mortality, which often requires multiple advanced interventions. SEMS can be applied in the airway and simultaneously in the digestive tract to temporarily seal the ADF as bridge to definitive surgical repair.
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来源期刊
ACS Applied Bio Materials
ACS Applied Bio Materials Chemistry-Chemistry (all)
CiteScore
9.40
自引率
2.10%
发文量
464
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