摘要目的 探讨继发于食管憩室的食管-支气管瘘的临床特征及误诊原因.方法 通过对一例继发于食管憩室的食管-支气管瘘患者的误诊、纠正诊断、治疗过程的分析,结合文献复习,总结该病的临床特征、分析误诊原因.以“食管憩室,食管-支气管瘘”为检索词检索万方数据库和中国期刊网全文数据库(CNKI),以esophageal diverticulum和esophageal bronchial fistula为检索词检索PubMed数据库,检索时间为1946年1月1日到2017年8月31日.结果 患者男,52岁,主因“反复咳嗽、咳黄脓痰20年余,加重伴咯血1年余”于北京协和医院就诊.曾在当地医院多次住院,多次行X线胸片及胸部CT等检查,先后诊断为肺部感染、支气管扩张伴感染、肺脓肿.1年前患者咳嗽、咳黄脓痰症状加重,间断伴有咯血,复查胸部CT示病灶进展,于北京协和医院经上消化道造影及电子胃镜诊断为食管中下段憩室并发食管-支气管瘘,后转诊至当地胸外科手术治愈.共检索到中文文献15篇,英文文献15篇,共报道病例35例.有误诊史28例,其中肺部感染19例、支气管扩张6例、肺脓肿4例.所有病例均有饮水呛咳史、均经上消化道造影和(或)电子胃镜检查确诊.结论 继发于食管憩室的食管-支气管瘘临床十分少见,其临床表现及影像学特征与支气管扩张、慢性肺脓肿极为相似,临床易被误诊.临床医生应提高诊断意识,详细询问病史,完善上消化道造影、胃镜和(或)支气管镜等检查,避免误诊和漏诊.明确诊断后应尽早手术.

abstractsObjective To investigate the clinical characteristics and causes of misdiagnosis of esophageal bronchial fistula secondary to esophageal diverticulum.Methods A case of esophageal bronchial fistula secondary to esophageal diverticulum was described with regard to its diagnosis and treatment process.A systematic literature review was performed for similar published cases in Wanfang,CNKI and Pubmed databases,using the key words "esophageal diverticulum,esophageal bronchial fistula" from January 1946 to August 2017.Results The patient was a 52 year-old man with a history of persistent cough with yellow purulent sputum for more than 20 years,which aggravated with hemoptysis for more than a year.He had been hospitalized several times at the local hospitals,and had undergone chest X radiography and computed tomography (CT) several times.He was variably diagnosed with pulmonary infection,bronchiectasis accompanied by infection,and pulmonary abscess.One year ago,the symptoms aggravated with excessive yellow purulent sputum,increased hemoptysis and progressive chest CT lesions.At Peking Union Medical College Hospital,the patient underwent upper gastrointestinal contrast and electronic gastroscopy,and was diagnosed with middle and lower segment esophageal diverticulum conplicated with esophageal-bronchial fistula.He was referred to the local thoracic surgery department for a curative procedure.By literature review,we found 15 relevant Chinese articles and 15 English articles.A total of 35 cases had been reported.In 28 misdiagnosed cases,lung infection was the most frequently diagnosed disease (19 cases),followed by bronchiectasis(6 cases) and pulmonary abscess(4 cases).All cases had a history of choking and coughing upon consuming liquids,and were confirmed through upper gastrointestinal contrast and/or electronic gastroscopy.Conclusion Esophageal bronchial fistula with esophageal diverticulum is a rare condition that can be misdiagnosed as bronchiectasis or chronic pulmonary abscess,due to the similarities in their clinical manifestations and imaging features.Detailed history-taking and upper gastrointestinal contrast,gastroscopy and/or bronchoscopy are useful for a timely and correct diagnosis.The recommended treatment for esophageal fistula secondary to esophageal diverticulum is immediate surgery.