食管异物并主动脉食管瘘的荟萃分析-现代医学

食管异物并主动脉食管瘘的荟萃分析

单位：1. 南京大学医学院附属泰康仙林鼓楼医院急诊医学科, 江苏南京 210046;
2. 南京大学医学院附属鼓楼医院消化内科, 江苏南京 210008

分类号：R768.3+2

出版年·卷·期（页码）：2018·46·第八期（920-923）

摘要：

目的：探讨食管异物所致主动脉食管瘘的诊断、治疗方法及预后情况。方法：联机检索Medline/Pubmed及OVID全文数据库，检索截止至2018年1月，并结合南京鼓楼医院诊治的6例患者，进行系统评价。结果：纳入10篇文献41例诊断明确的病例，加上南京鼓楼医院6例，共47例食管异物并主动脉食管瘘患者。该病以男性多见，中位年龄56岁，临床表现以胸骨后疼痛、前哨性出血及发热为主；多层螺旋CT检查表现多样，其中以16例提示纤维包裹型，25例提示假性动脉瘤，6例提示纵隔脓肿型。本组总体存活率34.0%，胸主动脉覆膜支架置入术组中存活率最高。结论：食管异物并主动脉食管瘘发生较为少见，但死亡率高，CT对病情评估有重要的价值，胸主动脉覆膜支架置入术对提高该病的救治成功率有重要的意义。

Objective:To investigate the diagnosis, treatment and prognosis of aortoesophageal fistulas secondary to foreign body. Methods:Data bases including Medline/Pubmed and OVID were searched electronically up to Jan 2018. A systematic review was performedwith 6 cases in Nanjing Drum Tower Hospital. Results:Ten articles fulfilling the criteria consisting of 41 patients with confirmed aortoesophageal fistulas secondary to foreign body were studied, together with 6 patients in Nanjing Drum Tower Hospital, finally 47 patients were included. The results of this systematic review showed:(1) Aortoesophageal fistulas secondary to foreign body was more common in men with a median age of 56. The most common clinical presentation were retrosternal pain, sentinel hemorrhage, and fever. (2) Aortoesophageal fistulas secondary to foreign body showed diverse imaging findings on multiple slices spiral CT, 16 cases showed fibrous capsule, 25 pseudoaneurysm, 6 mediastinum absces. (3) The survival rate in this group was 34.0%. The patients undergoing endovascular stent graft placement had the highest survival rate. Conclusions:Aortoesophageal fistulas secondary to foreign bodyare rare but almost always lethal. Multiple slices spiral CT plays an important role in evaluating the disease. Endovascular stent graft placementimproves the successful rate in treating such patients.

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