鱼骨移行致腹主动脉十二指肠瘘2例个案并文献复习

Abdominal Aortoduodenal Fistula Caused by Fishbone Migration: Two Cases and Literature Review

摘要: 误食鱼刺刺破上消化道的情况在临床上是常见的，但是鱼刺同时刺破十二指肠及腹主动脉壁并形成主动脉十二指肠瘘的病例是极其罕见的，严重时可引起患者失血性休克死亡。我院血管外科收治过两例主动脉十二指肠瘘患者，两例患者就诊的主诉均为不明原因的反复发热。其中女性患者3年前已被明确诊断为鱼刺刺破十二指肠和腹主动脉，入院行腹主动脉覆膜支架植入术外加十二指肠修补术；另一例男性患者4年前发生不明原因的腹主动脉破裂，行腹主动脉覆膜支架植入术，后在本次治疗过程中通过增强CT时发现腹主动脉内长形高密度异物影。本次对两位患者均行开腹探查手术，术中选择保留原支架，对支架周围组织行清创处理，关闭瘘口修补肠腔，使用大网膜覆盖腹主动脉，术前术后应用抗生素。本文讨论核心在于首次就诊是否应植入支架以及再次就诊支架是否可以保留。

Abstract: In clinical practice, it is common for patients to inadvertently ingest a fishbone that punctures the upper gastrointestinal tract. However, it is extremely rare for a fishbone to puncture both the ab-dominal aortic wall and the duodenum at the same time, resulting in the formation of an aortoduo-denal fistula. In severe cases, this can lead to hemorrhagic shock, which can be fatal. Two patients with aortoduodenal fistulas have been admitted to our hospital’s vascular surgery department. Both patients complained of an unexplained recurrent fever. The female patient was diagnosed with fishbone rupture of the duodenum and abdominal aorta three years prior, and she underwent duodenal repair in addition to abdominal aortic coated stent implantation. A long, high-density for-eign body was discovered inside the abdominal aorta during treatment for another male patient who experienced an unexplained abdominal aortic rupture four years prior. The initial stent was saved during the open exploratory procedure that was performed on both patients. Antibiotics were administered both before and after surgery, the tissue surrounding the stent was debrided, the intestinal lumen was repaired by closing the fistula, and a sizable omentum was placed over the abdominal aorta. This article mainly discusses whether or not a stent should be placed during the initial visit and if it can be saved for a follow-up appointment.