esophagobronchial fistula repair

The incidence of traction diverticulum in the middle esophagus is mostly caused by scar contraction and traction of mediastinal or hilar lymph node tuberculosis, and a small number is caused by pericarditis or spinal tuberculosis. This type of diverticulum only bulges outward without sagging, so generally does not accumulate food, is not easy to cause inflammation, and is not prone to obstruction of the esophageal lumen. However, due to the adhesion of scar tissue, it can affect the peristalsis of the esophagus. Sometimes, the diverticulum can develop inflammation, hemorrhage, form an abscess or break into the mediastinum. Due to the scar tissue around the diverticulum, acute perforation rarely occurs. There are also reports of diverticulum breaking into the aorta causing massive hemorrhage or breaking into the trachea to form esophageal tracheal fistula, as well as reports of non-lethal hemorrhage due to diverticulum breaking into the bronchial artery, possibly due to broken or calcified tissue of the brittle granulation tissue. Corrosion caused by bronchial artery. Dukes and Maclarty pointed out that mediastinal granulomatosis and esophagus are rare, but sometimes can compress the esophagus, causing esophageal stricture, the formation of diverticulum or sinus and the formation of esophageal fistula. Treatment of diseases: esophageal injury Indication Esophageal bronchospasm is not easy to heal, and can lead to severe lung infections and lung purulence, which must be treated surgically. Surgery should be performed through the thoracic incision to reveal the esophagus and tracheobronchial tree, determine the site of the hernia, close the fistula, and cover with a healthy pedicled pleural or muscle flap to reduce the chance of recurrence. At the same time, the diseased lungs that have been damaged and irreversible should be removed together. Some authors suggest that tracheostomy may be performed during surgery to prevent postoperative bronchial sutures from cracking and recurrence of sputum, as well as early bronchial lavage in the early postoperative period. If the closure of the esophageal fistula is found to be unsatisfactory during surgery, a cervical esophageal diversion and a gastrostomy may be performed. After the patient is restored, the reconstruction of the esophagus is considered. Surgical procedure 1, the incision is generally through the right chest posterolateral incision, the sixth rib into the chest. 2, revealing the fistula such as the membranous or band-like adhesion in the chest, to be separated. The right lung is pulled forward and the pleural pleura of the middle part of the esophagus is cut, and the fistula of the esophagus and the right main bronchus can be dissected by dissecting the right side of the esophagus and the lower edge of the tracheal bifurcation. 3. Thoroughly remove the granulation tissue and scar tissue around the fistula and remove the inflammatory or calcified lymph nodes. The fistula is ligated and cut, and a part of the fistula can be removed. The two ends of the fistula were sutured with a thin wire, and then covered with the adjacent mediastinal pleura to cover the two ends of the esophagus and bronchospasm and sutured.