Bryant Ayesha S, Cerfolio Robert J
Department of Epidemiology, University of Alabama at Birmingham, 1900 UniversitY Boulevard, Birmingham, AL 65294, USA.
Thorac Surg Clin. 2007 Feb;17(1):63-72. doi: 10.1016/j.thorsurg.2007.02.003.
Injury from blunt or penetrating trauma to the esophagus is relatively rare. Treatment strategy is contingent on the clinical status of the patient, associated injuries, and the degree of esophageal injury and the time of injury until diagnosis. Although nonoperative intervention may be acceptable in highly selected patients with contained injuries or those who are more than 24 hours removed from the injury and are clinically stable, operative intervention is the most conservative and safest approach. There are many potential surgical approaches but resection or diversion should be discouraged. Operative approaches include either side of the neck or chest, and an abdominal approach for selected injuries. Sometimes combined incisions are needed. The goal of any operation for a traumatic esophageal injury is removal of infected material, debridement of the esophagus, assessment of the distal and proximal extent of the injury, decortication of the lung if the injury soils the pleural space, primary closure of the esophageal defect if possible with buttressing of the closure with autologous pedicles tissue or muscle flaps, and to ensure distal patency without esophageal pathology.
钝性或穿透性创伤导致的食管损伤相对少见。治疗策略取决于患者的临床状况、合并伤、食管损伤的程度以及从受伤到诊断的时间。尽管对于少数有局限性损伤的患者或受伤超过24小时且临床稳定的患者，非手术干预可能是可以接受的，但手术干预是最保守和最安全的方法。有许多潜在的手术入路，但应避免进行切除或转流手术。手术入路包括颈部或胸部的任一侧，以及针对特定损伤的腹部入路。有时需要联合切口。创伤性食管损伤的任何手术目标都是清除感染物质、对食管进行清创、评估损伤的远端和近端范围、如果损伤污染了胸膜腔则对肺进行剥脱、如果可能则对食管缺损进行一期缝合并用自体带蒂组织或肌瓣加强缝合，并确保远端通畅且无食管病变。
