From the Division of Trauma and Surgical Critical Care (M.S., K.I., J.M.B., L.L., E.B., D.G., D.D.), LAC + USC Medical Center, and Keck School of Medicine (D.O.), University of Southern California, Los Angeles, California.
J Trauma Acute Care Surg. 2017 Nov;83(5):798-802. doi: 10.1097/TA.0000000000001563.
Injuries to the gastroesophageal (GE) junction are infrequently encountered because of the high mortality of associated injuries. Consequently, there is a paucity of literature on the patient demographics and treatment options. The aim of this study was to examine the epidemiology, surgical management, and outcomes of these rare injuries.
Patients presenting to LAC + USC Medical Center (January 2008 to August 2016) with traumatic esophageal or gastric injury (DRG International Classification of Diseases-9th Rev.-Clinical Modification and 10th Rev. codes) were extracted from the trauma registry. Patient charts were reviewed, and all patients who sustained an injury to the GE junction were enrolled. Patient demographics, injury characteristics, procedures, and outcomes were analyzed.
Of the 238 patients who sustained an injury to the esophagus or stomach during the study period, 28 (12%) were found to have a GE junction injury. Mean age was 26 years (range, 14-57 years), 89% male. Mechanism of injury was penetrating in 96% (n = 27), the majority of which were gunshot wounds (n = 22, 81%). Most patients (n = 18, 64%) were taken directly to the operating room. Ten (36%) underwent computed tomography scan before going to the operating room, all demonstrating a GE junction injury. All patients underwent repair via laparotomy. One (4%) also required thoracotomy to facilitate delayed reconstruction. GE junction injuries were typically managed with primary repair (n = 22, 79%). Associated injuries were frequent (n = 26, 93%), and injury severity was high (mean Injury Severity Score, 25 [9-75]). Mortality was 25% (n = 7), and all patients required intensive care unit admission. Most did not require total parenteral nutrition (n = 25, 89%) or a surgically placed feeding tube (n = 26, 93%). Of the 13 patients who presented for clinical follow-up, all but one (n = 12, 92%) were eating independently by the first clinic visit.
GE junction injuries are uncommon and occur almost exclusively after penetrating trauma. Patients are severely injured with a high mortality rate and frequently have associated intracavitary injuries. Most can be fixed through the abdomen alone and do not require thoracotomy for repair. Despite the severity of injuries, the majority of survivors are eating independently by the first clinic visit.
Epidemiological, level V.
由于相关损伤的死亡率很高，因此很少发生胃食管（GE）交界处损伤。因此，有关此类罕见损伤的患者人口统计学和治疗选择的文献很少。本研究的目的是检查这些罕见损伤的流行病学，外科治疗和结果。
从创伤登记处提取了 2008 年 1 月至 2016 年 8 月在 LAC + USC 医疗中心就诊的外伤性食管或胃损伤患者（DRG 国际疾病分类-9 修订版-临床修正和 10 修订版代码）。查阅了患者的病历，所有发生 GE 交界处损伤的患者均被纳入研究。分析了患者的人口统计学特征，损伤特征，手术程序和结果。
在研究期间，238 例食管或胃损伤患者中，有 28 例（12％）发现 GE 交界处损伤。平均年龄为 26 岁（范围 14-57 岁），男性占 89％。96％（n = 27）的损伤机制为穿透性，其中大多数为枪伤（n = 22，81％）。大多数患者（n = 18，64％）直接进入手术室。10 例（36％）在进入手术室前进行了计算机断层扫描，所有患者均显示 GE 交界处损伤。所有患者均通过剖腹手术进行修复。有 1 例（4％）还需要开胸手术以方便延迟重建。GE 交界处损伤通常通过初次修复进行治疗（n = 22，79％）。常伴有合并伤（n = 26，93％），损伤严重程度高（平均损伤严重程度评分 25 [9-75]）。死亡率为 25％（n = 7），所有患者均需入住重症监护病房。大多数患者不需要全胃肠外营养（n = 25，89％）或手术置管喂养（n = 26，93％）。在接受临床随访的 13 例患者中，除 1 例（n = 12，92％）外，其余患者在首次就诊时均能独立进食。
GE 交界处损伤很少见，几乎仅发生在穿透性创伤后。患者受伤严重，死亡率高，常有腔内脏器合并伤。大多数可以仅通过腹部固定，不需要开胸手术修复。尽管损伤严重，但大多数幸存者在首次就诊时即可独立进食。
流行病学，5 级。
