Tracheoesophageal Fistula Caused by Candidiasis: A Case Report

念珠菌感染導致氣管食道廔管之病例報告

呂宏益(Hung-I Lu) ； 謝敏暲(Ming-Jang Hsieh) ； 黃昭誠(Chao-Cheng Huang) ； 張仁平(Jen-Ping Chang)

《胸腔醫學》 18卷2期 (2003/04) Pp. 181-186

摘要

念珠菌感染導致氣管食道廔管極為罕見。一般而言，非惡性腫瘤導致之後天性氣管食道廔管，主要的致病機轉為醫源性、外傷性、或感染性等病因所形成。其中又以氣管內管置入或長期氣切管置入等醫源性病因最為常見。而感染性病因如結核菌、念珠菌或病毒感染等病因則相當少見。食道的念珠菌感染很少發生在免疫能力正常的人身上，但是一旦感染後延誤診斷及治療時機，仍會導致食道出血、狹窄、或是與呼吸道的廔管等嚴重的併發症。
本病例經食道攝影及支氣管鏡檢查診斷為中段氣管食道廔管；藉由氣管食道廔管及氣管的病理切片檢查證實為念珠菌感染。經施予廔管切除及食道修補手術，合併感染段氣管切除及吻合手術，再輔以肌肉皮瓣覆蓋，隔離食道及氣管吻合處以防廔管復發等治療後痊癒。
此種非結核菌感染性病因所致之後天性氣管食道廔管，在治療上除了先予以感染控制及營養支持外，在病況允許下仍應以根除性外科治療為主，以達較佳之治療效果。

關鍵字

念珠菌感染 ； 氣管食道廔管

並列摘要

Tracheoesophageal fistulas (TEF) caused by Candida infection are rare. Acquired tracheoesophageal fistulas are severe lesions leading to serious and ultimately fatal pulmonary complications. Treatment is made difficult by need to manage the consequences of esophagotracheal communication and of the illness responsible for the fistula. This report describes a 53-year-old man who presented with frequent choking and coughing with bloody sputum for one week. The esophagogram and bronchoscopy revealed a tracheoesophagal fistula at the level of the second thoracic vertebra. A full sternotomy was performed with one-stage esophageal repair combined with tracheal resection and anastomosis. The TEF was closed and the patient recovered well. Pathologic examinations of the TEF and trachea displayed an ulcer with candidiasis. No recurrence of fistula was detected during follow-up.

並列關鍵字

tracheoesophageal fistula ； candidiasis