李佳?林宇?林冬群?赵青武?黄伯湘?李永锋?陈记财

【摘要】主动脉食管瘘（AEF）是一种少见但预后极其凶险的疾病，处理不及时可引起严重感染和上消化道大出血。国内报道以食管异物引发的AEF常见，而国外报道则以大动脉疾病手术和主动脉瘤导致的AEF为主。该文报道1例胸主动脉瘤致AEF病例，患者为74岁男性，因降主动脉穿透性溃疡并假性动脉瘤破裂行主动脉支架植入术，术后发生AEF，并出现纵隔感染，在病情稳定后再次出现食管瘘口扩大及消化道出血，虽经积极抢救，但终因失血性休克死亡。临床上遇到有AEF高危因素和典型症状的患者应及早诊断，对于症状不典型的患者，接诊医师应拓宽诊断思路，提高警惕性，实施主动脉支架植入术后应注重广谱抗生素的应用，积极治疗纵隔感染。

【关键词】主动脉瘤;主动脉食管瘘;主动脉支架植入术;失血性休克;抗感染

Aortoesophageal fistula induced by thoracic aortic aneurysm： report of one case Li Jia， Lin Yu， Lin Dongqun， Zhao Qingwu， Huang Boxiang， Li Yongfeng， Chen Jicai. Department of Thoracic and Cardiovascu-lar Surgery， Guangdong Provincial Hospital of Chinese Medicine， Guangzhou 510120， China

Corresponding author， Li Jia， E-mail： ljxy1981@ 163. com

【Abstract】Aortoesophageal fistula （AEF） is a rare and potentially fatal disease with poor prognosis. Without immediate treatment， AEF may cause severe infection and massive hemorrhage in the upper gastrointestinal tract. Foreign body in the esophagus is the most common cause of AEF in domestic reports， whereas surgery of aortic diseases and thoracic aortic aneurysm are the main causes of AEF in foreign researches. In this article， we presented one case of AEF induced by thoracic aortic aneurysm. A 74-year-old male patient underwent endovascular thoracic aortic stent for the penetrating ulcer of the descending aorta complicated with pseudoaneurysm rupture. Postoperatively， he suffered from AEF complicated with mediastinal infection. After the disease condition was stablized， he repeatedly presented with esophageal fistula enlargement and gastrointestional hemorrhage. He eventually died from hemorrhagic shock even after active rescue. Early diagnosis should be delivered for patients with risk factors and typical symptoms of AEF. For those with atypical symptoms， physicians should widen diagnostic thinkings and remain alerted to the possibility of AEF. After endovascular thoracic aortic stent， broad-spectrum antibiotic therapy should be performed to treat the mediastinal infection.

【Key words】Aortic aneurysm;Aortoesophageal fistula;Endovascular thoracic aortic stent;

Hemorrhagic shock;Anti-infection

主動脉食管瘘（AEF）是一种少见但预后极其凶险的疾病，发病率约0.01% ～ 0.08%[1]。自1818年法国神经外科医师Dubrueil报道首例AEF后，1980年才出现首例救治成功的病例[2-3]。该病通常由各种食道和主动脉疾病引起，食道和主动脉之间出现异常通道，若处理不及时可引起严重感染和上消化道大出血，危及生命[4]。AEF最常见的病因有大动脉疾病手术、主动脉瘤、异物和胸部肿瘤，还有一些少见病因如创伤、结核等。我国报道以食管异物引发的AEF常见，而国外报道则以大动脉疾病手术和主动脉瘤导致的AEF为主。胸主动脉瘤所致的AEF常因诊断困难而被延误，多数病例直至急诊手术探查或死亡尸体解剖才被确诊。……