Hernández Hernández Juan Ramón, Navarro Barlés Gonzalo, López-Tomassetti Fernández Eudaldo M, Vega Benítez Victor, Núñez Jorge Valentín
Departamento de Cirugía General, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España.
Thorac Cancer. 2013 Feb;4(1):71-74. doi: 10.1111/j.1759-7714.2012.00112.x.
This article features the case study of a 32-year-old female patient who had undergone surgery to remove a cervical spine tumor and who later developed cervical esophagus necrosis secondary to the erosion caused by an osteosynthesis 13 years after her prosthetic cervical surgery. Barium swallow did not show anything abnormal, but after an emergency spiral computerized axial tomography (CAT) scan, a paravertebral abscess was found, along with displacement of the fixation plate and the disappearance of the esophageal silhouette on coronal sections. The patient underwent surgery to drain the abscess, extract the osteosynthesis materials and the stabilization plates, and to perform a temporary esophageal exclusion. Two months after this surgery the esophagus was reconstructed by performing a retrosternal pharyngogastrostomy without resection of the remaining cervicothoracic esophagus due to severe fibrosis and the absence of local recurrence. During the immediate post operatory period the patient developed a cervical fistula and after a month of conservative treatment, severe dysphagia was observed. Imaging tests showed a spontaneous fistula from the pharynx to the native esophagus, which prompted extraordinary treatment. Therefore, a jejunal loop was taken to the esophagus in the hiatus with a Roux-en-Y anastomosis to resolve this condition.
本文介绍了一名32岁女性患者的病例研究。该患者曾接受颈椎肿瘤切除手术，在人工颈椎手术后13年，因骨固定术造成的侵蚀继发颈椎食管坏死。吞钡检查未显示任何异常，但在紧急螺旋计算机断层扫描（CAT）后，发现了椎旁脓肿，同时固定钢板移位，冠状面上食管轮廓消失。患者接受了手术，以引流脓肿、取出骨固定材料和稳定钢板，并进行临时食管排除。此次手术后两个月，由于严重纤维化且无局部复发，在未切除剩余颈胸段食管的情况下，通过胸骨后咽胃吻合术重建了食管。术后即刻，患者出现颈瘘，经过一个月的保守治疗后，观察到严重吞咽困难。影像学检查显示从咽部到原生食管的自发性瘘管，这促使进行特殊治疗。因此，采用空肠袢经裂孔至食管并进行Roux-en-Y吻合术来解决此问题。
