Experience of diagnosis and treatment for cervical tracheoesophageal fistula complicated with laryngotracheal stenosis

Objective To explore the treatment of cervical tracheoesophageal fistula （TEF） with complicated or remnant laryngotracheal stenosis （LTS） and anterior neck defect （AND）. Methods From 1980 to 2007,14 patients were diagnosed as TEF. Among them, 9 patients had complicated or remnant LTS, 3 patients had complicated AND, and 2 patients had TEF which were induced by Nickel-Titaium alloy mesh stent for treating benign esophageal stricture. All these patients were retrospectively studied in Tangdu Hospital. Treatment consisted of conservative therapy of TEF, staged surgical repair of TEF and laryngotracheal reconstruction according to the dimension （small or large ） of TEF and complications. Results Four patients with small TEF （2 - 3 mm length ） complicated LTS underwent laryngotracheal reconstruction stented with silicone T tube and TEF was adopted conservative treatment. The TEF and LTS were healed. Six patients with larger TEF （ 10 - 25 mm length） were repaired by staged surgical repair of TEF and laryngotracheal reconstruction. Among them, 3 cases had complicated LTS and AND, 2 cases had rement LTS and 1 case had TEF without complication. Two patients had TEF and LTS, whose TEF healed before laryngotrucheal reconstruction, the remnant LTS were reconstructed and healed. During the follow-up ranged from one to ten years, 12 patients were successfully treated without complications. One patient with TEF and LTS was treated only LTS because of a segment of esophagus was closed and treated with esophugogastrostomy in the department of thoracic surgery after LTS was successfully reconstructed and cured. One patient died of bleeding and asphyxia induced by the Nickel-Titanium alloy stent because of the stent had not been taken out. Conclusion The small cervical TEF complicated or remnant LTS can be treated by laryngotracheal reconstruction and conservative treatment of TEF at the same time. A larger TEF complicated LTS should be treated by staged repair of TEF and LTS. Key words: Tracheoesophageal fistula; Laryngostenosis; Tracheal stenosis; Cutaneous fistula; Surgical procedures, operative