Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Ann Thorac Surg. 2010 Oct;90(4):1128-33. doi: 10.1016/j.athoracsur.2010.06.045.
Esophageal injury is a rare but catastrophic complication of anterior cervical spine surgery. Cases of esophageal perforation may be discovered intraoperatively, or as late as 10 years after surgery. In the current study we aim to review the principles of care and provide an algorithm that can be employed for successful management of this complex problem.
We performed a retrospective, Institutional Review Board-approved review of esophageal injuries resulting from anterior cervical spine surgery that were managed at our institution between January 1, 2007 and July 31, 2009. We collected demographic information, perioperative data, and final outcomes. Data were analyzed using descriptive statistics.
We identified 6 patients who met our criteria. All patients presented with esophageal leaks, neck abscesses, and osteomyelitis. Similarly, all had been treated prior to transfer, without resolution of their leak. After debridement, removal of hardware, long-term antibiotic therapy, maximization of nutrition, and supportive care, 80% of patients resumed oral intake (median time 66.5 days). Mortality was 16.7%.
Neck exploration with removal of hardware, debridement, and open neck wound management are the basic principles of care. Management is often prolonged and requires multiple procedures; however, with persistence, closure is possible in the majority of patients. Our report serves as a guide for the treatment of this devastating problem.
食管损伤是颈椎前路手术罕见但灾难性的并发症。食管穿孔的病例可能在术中发现，也可能在手术后 10 年发现。在目前的研究中，我们旨在回顾治疗原则，并提供一种可用于成功处理这一复杂问题的算法。
我们对 2007 年 1 月 1 日至 2009 年 7 月 31 日期间在我院治疗的颈椎前路手术后食管损伤进行了回顾性、机构审查委员会批准的回顾。我们收集了人口统计学信息、围手术期数据和最终结果。使用描述性统计对数据进行分析。
我们确定了 6 名符合我们标准的患者。所有患者均出现食管漏、颈部脓肿和骨髓炎。同样，所有患者在转诊前都接受了治疗，但未能解决漏液问题。清创、去除硬件、长期抗生素治疗、最大限度地提供营养和支持治疗后，80%的患者恢复了口服饮食（中位数时间为 66.5 天）。死亡率为 16.7%。
颈部探查、去除硬件、清创和开放颈部伤口管理是基本的治疗原则。治疗往往是长期的，需要多次手术；然而，只要坚持，大多数患者都有可能愈合。我们的报告为治疗这一毁灭性问题提供了指导。
