心房食管瘘1例并文献复习分析

doi:10.16138/j.1673-6087.2021.04.003

摘要/Abstract

摘要：

目的：总结分析心房食管瘘（atrioesophageal fistula,AEF）患者的临床特点、诊治及预后,提高临床诊治水平。方法：报告我院收治的1例AEF患者,以“atrioesophageal fistula”为检索词,在PubMed数据库检索。以“心房食管瘘”为检索词,在万方数据库检索,检索时间截至2020年6月。结果：检索到AEF相关英文文献83篇,共报道病例38例。相关中文文献3篇,报道病例5例。剔除资料不详者,最终筛选获得41例,联合本例,针对42例进行文献复习。42例患者中男性33例,女性9例,平均年龄（58.02±13.47）（27~78）岁;射频消融术至出现AEF的时间间隔平均为（23.74±11.44）（1~50） d。患者常见的临床表现为发热、神经系统症状、胸闷/胸痛、消化道出血、咯血。死亡组患者年龄高于存活组[（62.25±12.29）岁比（52.38±13.19）岁,P<0.05],存活组手术治疗患者所占比例高于死亡组（16/18比8/24, P<0.05）,Logistic回归分析显示手术治疗是患者存活的保护因素。结论：AEF是射频消融治疗的严重并发症,患者死亡率高,手术治疗可提高患者的生存率。

关键词: 心房食管瘘, 射频消融术, 治疗

Abstract:

Objective To analyze the clinical feature, diagnosis, treatment and prognosis of the patients with atrioesophageal fistula(AEF). Methods A patient with AEF admitted to our hospital was reported and the related literatures were reviewed. “Atrioesophageal fistula” was used as the keyword to retrieve the literature from Pubmed database and Wanfang database until June 2020. Results Eighty-three English and 3 Chinese documents related to AEF were retrieved. A total of 43 patients were reported. Forty-one cases were finally enrolled, combined with this case, 42 cases were reviewed. Thirty-three were male and 9 were female in 42 cases, and age range was 27-78 years [mean age (58.02±13.47) years]. The onset of symptoms after the procedure of radiofrequency ablation was 1-50 d, and the average time was(23.74±11.44) d. The common clinical manifestations of patients were fever, nervous system symptoms, chest tightness/chest pain, gastrointestinal bleeding and hemoptysis. The patients were divided into survival group and death group. Compared with survival group, the age in the death group were higher [(62.25±12.29) years vs. (52.38±13.19) years, P<0.05]. The proportion of patients treated with surgery in the survival group was higher than that in the death group (16/18 vs 8/24, P<0.05). Logistic regression analysis showed that surgical treatment was an independent protective factor for patients. Conclusions AEF is a serious complication of radiofrequency ablation. The mortality rate of patients is high, and surgical treatment can improve the survival rate of patients.

Key words: Atrioesophageal fistula, Radiofrequency catheter alblation, Treatment

中图分类号:

R571

董艳彬, 李华, 茆丽娜. 心房食管瘘1例并文献复习分析[J]. 内科理论与实践, 2021, 16(04): 234-239.

DONG Yanbin, LI Hua, MAO Lina. Atrioesophageal fistula: a case report and literature review[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(04): 234-239.

图/表 3

参考文献 45

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临床特征	存活组(n=18)	死亡组（n=24）	χ²/t	P
男性[n（%）]	16（88.9）	17（70.8）	1.064	0.302
年龄（岁）	52.38±13.19	62.25±12.29	-2.493	0.017
消融至出现症状时间（d）	22.83±12.74	24.42±10.59	-0.439	0.663
发热[n（%）]	17（94.4）	23（95.8）	-	1.000
胸闷/胸痛[n（%）]	8（44.4）	8（33.3）	0.538	0.463
消化道出血[n（%）]	3（16.7）	6（25.0）	0.074	0.786
咯血[n（%）]	0（0）	1（4.17）	-	1.000
神经系统症状[n（%）]	13（72.2）	23（95.8）	2.953	0.086
保守治疗[n（%）]	1（5.56）	15（62.5）	14.143	0.000
外科手术治疗[n（%）]	16（88.9）	8（33.3）	12.963	0.000
支架置入[n（%）]	1（5.6）	1（4.17）	0.067	0.795