颈段食管穿透伤：常规探查是否必要？

Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

作者信息

Madiba T E, Muckart D J J

机构信息

Department of Surgery, University of Natal and King Edward VIII Hospital, Durban, South Africa.

出版信息

Ann R Coll Surg Engl. 2003 May;85(3):162-6. doi: 10.1308/003588403321661307.

DOI:10.1308/003588403321661307

PMID:12831487

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1964361/

Abstract

BACKGROUND

There are differing views regarding the management of oesophageal injuries with some authors advocating mandatory operation while others prefer a selective, conservative approach. This study was undertaken to establish whether conservative management of cervical oesophageal injuries is safe and effective.

PATIENTS AND METHODS

This is a retrospective study carried out over 5 years (1994-1998). Of 1358 patients with neck trauma, 220 presented with odynophagia, of whom 28 were shown on contrast swallow to have cervical oesophageal injury (17 stabs, 11 firearms). Median age was 26 years (range, 11-44 years). There were 23 males (M:F ratio, 6:1). All patients with contained extravasation were managed non-operatively irrespective of the delay from injury to admission. Repair was undertaken in patients with major disruption and those requiring exploration for another reason. Associated tracheal injuries were repaired primarily with or without tracheostomy. Patients were fed using fine bore enteral feeding tubes. Oral feeding was recommenced after a water soluble contrast swallow had confirmed healing.

RESULTS

All patients presented with odynophagia. Seven had clinical surgical emphysema, and 15 had retropharyngeal air on lateral neck X-ray. Chest X-ray showed surgical emphysema in 8, haemothorax in 2 and pneumothorax in 2. Seventeen patients were managed non-operatively. Sixteen recovered with no complications, while one developed local sepsis. Eleven patients underwent exploration (debridement in 7 and primary repair in 4). There were 6 associated tracheal injuries, all of whom underwent primary repair with tracheostomy performed in four. Thirteen patients were admitted to the intensive care unit. Median duration of enteral tube feeding was 18 days (range, 5-40 days) and median hospital stay was 18 days (range, 6-91 days). Two patients with firearm injuries died from associated injuries.

CONCLUSION

Non-operative management of penetrating injuries to the cervical oesophagus is safe and effective.

摘要

背景

关于食管损伤的处理存在不同观点，一些作者主张强制手术，而另一些人则倾向于选择性的保守方法。本研究旨在确定对颈部食管损伤进行保守治疗是否安全有效。

患者与方法

这是一项为期5年（1994 - 1998年）的回顾性研究。在1358例颈部创伤患者中，220例出现吞咽痛，其中28例经吞咽造影显示有颈部食管损伤（17例刺伤，11例枪伤）。中位年龄为26岁（范围11 - 44岁）。男性23例（男女比例为6:1）。所有局限性外渗患者均接受非手术治疗，无论从受伤到入院的延迟时间长短。对有严重破裂的患者以及因其他原因需要探查的患者进行修复。合并气管损伤的患者主要进行修复，部分患者同时行气管切开术。患者通过细孔肠内喂养管进食。在水溶性造影剂吞咽检查证实愈合后重新开始经口进食。

结果

所有患者均有吞咽痛。7例有临床手术性气肿，15例颈部侧位X线片显示咽后积气。胸部X线片显示8例有手术性气肿，2例有血胸，2例有气胸。17例患者接受非手术治疗。16例康复且无并发症，1例发生局部感染。11例患者接受探查（7例行清创术，4例行一期修复）。有6例合并气管损伤，均进行了一期修复，4例行气管切开术。13例患者入住重症监护病房。肠内管饲的中位持续时间为18天（范围5 - 40天），中位住院时间为18天（范围6 - 91天）。2例枪伤患者因相关损伤死亡。