Cancer of the trachea – the causes and treatment of esophageal fistula

By | January 21, 2012

Lung cancer patients with invasive growth of tumors in the trachea, can damage the tracheal wall and esophagus causing a tracheal esophageal fistula. Tracheal cancer more than a fistula caused by the esophageal cancer. Since there is no serosa esophageal cancer tissue around the esophagus and easy to violations of the trachea, necrosis, fistula can be formed. However, more fistula are the sequelae of radiotherapy because of radiation to kill tumor tissue and normal tissue damage may also form a fistula; Secondly, the rapid tumor necrosis after radiotherapy and normal tissue can also form barriers to fistula repair. Untreated fistula led to persistent lung infection and in patients with life-threatening eating disorder and, at this time were mainly for cough after eating, obviously, especially when eating liquid food. Therefore, the treatment of malignant lesions than fistula closure is more important.
The causes and treatment of esophageal fistula in the main treatment methods:
(1) surgical bypass surgery: cervical esophagus, such as TIF, and gastrostomy tube palliative treatment of cancer – esophageal fistula. However, a higher mortality rate, and can not eat by mouth, poor quality of life.
(2) non-expandable esophageal prosthesis: rigid plastic pipes, such as oral or esophageal gastric stoma into palliative treatment of esophageal – tracheal fistula.
(3) covered self-expanding metal stent implantation: operation under topical anesthesia in the pharynx, the patient side in the examination bed, put off the denture, Yao Jinya care. x cable television under the surveillance of the guide wire into the catheter through the mouth through the stricture lesions, direct distal stomach. 25% of injected via the catheter confirmed meglumine plastic catheter in the gastric lumen, and then sent to strengthen the guide wire along the catheter. Obvious lesions narrow the esophagus, with a gradual expansion to the dilator 0.9 -1. 2cm. Along the guide wire will be covered with a metal stent delivery system into the narrow Ministry, accurate positioning eluting stent, stent expansion to be satisfied with the slow withdrawal of delivery system, the esophageal stent placement in the fistula and stenosis. Observed immediately after oral administration of dilute sulfuric acid lock fistula closure, stand clear whether the opening situation and esophageal perforation, stent ectopic release. The treatment of malignant esophageal – tracheal fistula closure quickly, lifting the combined esophageal stenosis and restore eating, effective control of aspiration pneumonia, improving physical fitness of patients, radiotherapy or chemotherapy to continue to provide a basis. Therefore, the esophageal stent implantation could improve the quality of life and prolong survival.
(4) Photodynamic therapy: tracheal endoscopic and / or use of photodynamic therapy under gastroscope to remove tumor tissue fistula, so that the growth of normal mucosa, fistula healing. Since the beginning of this method after a large number of tumor necrosis, fistula may be further increased, but with the growth of normal tissue around the lesion, will be gradually reduced to fistula healing. Photodynamic therapy should be carried out before the stent placement.
(5) Other: holes in those less than 3mm, 10% silver nitrate, Mongolia mixture, high-speed Jie, such as fibrin glue repair.
The causes and treatment of esophageal fistula, malignant tracheal esophageal fistula need a comprehensive treatment. First, stent placement, fistula closure in a timely manner to maintain the normal swallowing function. Second, the selection of antibiotics to control infection is sensitive to rescue important measures of life of patients; for long-term fasting patients, intravenous hyperalimentation therapy, intermittent blood transfusion or fresh plasma to enhance the supportive therapy and correction of electrolyte disorders. Again, the anti-tumor therapy.
Typical cases:
Mr. Han, 75. Main cause of "esophageal cancer 1 year after surgery, drinking cough 1 week" admission.
1 years ago, eating in patients with a sense of choking, the local hospital endoscopy showed esophageal squamous cell carcinoma line. Multiple lines of chemotherapy, 2 months ago radiotherapy 28 days. 1 week ago there drinking cough, this hospital for further treatment. Bronchoscopy were at the hospital prompted the lower posterior tracheal mucosal defects, esophageal – tracheal fistula formation.
The causes and treatment of esophageal fistula in the treatment process: After bronchoscopy, the fistula location specific, custom pipe "Y"-shaped bracket.
Patients supine in the digital subtraction fluoroscopy machine in the trachea through the mouth into the Y-shaped capsule built-in support, the sinus blockage in the stent behind. Review bronchoscopy showed good stent position and release, completely blocked the fistula. Patients after a normal diet, no cough.

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