Wang Shao-bo, Wang Sheng-lin, Ma Qing-jun, Liu Dan-dan, Zhang Ji-fa, Zhang Xue-li
Department of Orthopaedics, the Third Hospital of Peking University, Beijing 100083, China.
Zhonghua Wai Ke Za Zhi. 2004 Nov 7;42(21):1319-21.
To evaluate the causes, diagnosis, treatment and prevention of esophagocutaneous fistula in anterior cervical spine surgery.
Thirteen cases with esophagocutaneous fistula in anterior cervical spine surgery were studied.
The causes includes: (1) During the operation, esophagus was oppressed by a clasp for so long time that made a pressure necrosis of the esophagus; (2) Esophagus was injured by loose plates and screws; (3) Loose bone grafts oppressed esophagus; (4) Esophagus was injured by operative appliance in the operation; (5) Esophagus was oppressed by the plate.
After anterior cervical spine surgery if patients had a high fever, sore throat, swelling incision, and food sediment was found in the incision, esophagocutaneous fistula should be considered. The final diagnosis could be done by esophageal radiography.
Fasting cure, nasogastric tube and wound drainage should be used; When the inflammation ended, patients should undergo operation of closure of the esophageal fistula.
The esophagocutaneous fistula in anterior cervical spine surgery has several causes mentioned above. We should take precautionary measures to avoid the complication, and use appropriate treatment to cure when it happens.
评估颈椎前路手术中食管皮肤瘘的病因、诊断、治疗及预防措施。
对13例颈椎前路手术后发生食管皮肤瘘的病例进行研究。
病因包括:(1)术中食管被卡子长时间压迫导致食管压迫性坏死;(2)食管被松动的钢板和螺钉损伤;(3)松动的植骨块压迫食管;(4)术中手术器械损伤食管;(5)钢板压迫食管。
颈椎前路手术后若患者出现高热、咽痛、切口肿胀且切口内有食物残渣,应考虑食管皮肤瘘。最终诊断可通过食管造影完成。
采用禁食、胃肠减压及伤口引流;炎症消退后,患者应接受食管瘘修补手术。
颈椎前路手术中的食管皮肤瘘有上述多种病因。我们应采取预防措施避免该并发症,发生时采用恰当治疗方法进行治愈。