Ardon H, Van Calenbergh F, Van Raemdonck D, Nafteux P, Depreitere B, van Loon J, Goffin J
Department of Neurosurgery, University Hospital Leuven, Leuven, Belgium.
Acta Neurochir (Wien). 2009 Apr;151(4):297-302; discussion 302. doi: 10.1007/s00701-009-0241-5. Epub 2009 Mar 3.
Oesophageal perforation related to anterior cervical surgery is an uncommon but well recognised and potentially life-threatening complication with an incidence of 0-3.4%. Our experience with this complication and a review of the literature are presented.
We retrospectively reviewed our clinical experience over 10 years and found four patients in whom an oesophageal perforation was recognised after anterior surgery for cervical spine trauma. In three patients the perforation was noticed in the early post-operative period and the other had a delayed presentation. In all patients, the hardware was removed, long-term intravenous antibiotics were administered and parenteral nutrition was instituted. In two patients a primary suture of the perforation was performed and in one of these an additional sternocleidomastoid myoplasty was carried out as well. One patient had conservative treatment and one died before closure of the perforation could be performed.
The two patients, in whom surgical repair of the perforation was performed, recovered well with residual neurological deficits as expected due to the cervical trauma. In the patient in whom conservative treatment was instituted, healing of the perforation occurred. One patient died due to systemic complications, indirectly related to the perforation.
Although not very frequent and sometimes difficult to diagnose, oesophageal perforations after anterior cervical surgery constitute a potentially life-threatening complication. Diagnosis is made by imaging or endoscopic studies, but clinical suspicion is most important. Basic treatment consists of surgery with removal of hardware, drainage of abscesses, primary closure of the perforation if possible, parenteral nutrition and antibiotic therapy. Residual instability should be recognised in time and may be anticipated in patients in whom there has been little time for solid bony fusion. Successful management depends on early diagnosis and immediate institution of treatment.
与颈椎前路手术相关的食管穿孔是一种罕见但已被充分认识且可能危及生命的并发症，发生率为0 - 3.4%。本文介绍了我们对该并发症的经验及文献回顾。
我们回顾了10年的临床经验，发现4例颈椎前路创伤手术后发生食管穿孔的患者。3例患者在术后早期发现穿孔，另1例出现延迟表现。所有患者均取出内固定物，长期静脉使用抗生素并给予肠外营养。2例患者进行了穿孔的一期缝合，其中1例还进行了胸锁乳突肌肌成形术。1例患者接受保守治疗，1例在穿孔闭合前死亡。
2例行穿孔手术修复的患者恢复良好，但因颈椎创伤遗留预期的神经功能缺损。接受保守治疗的患者穿孔愈合。1例患者因与穿孔间接相关的全身并发症死亡。
尽管颈椎前路手术后食管穿孔并不常见且有时难以诊断，但它是一种潜在的危及生命的并发症。通过影像学或内镜检查进行诊断，但临床怀疑最为重要。基本治疗包括手术取出内固定物、脓肿引流、尽可能一期闭合穿孔、肠外营养和抗生素治疗。应及时认识到残留不稳定情况，对于没有足够时间实现牢固骨融合的患者可能需要提前预期。成功的治疗取决于早期诊断和立即开始治疗。
