Ferguson M K, Migliore M, Staszak V M, Little A G
Department of Surgery, University of Chicago Medical Center, Illinois 60637.
Am J Surg. 1989 Jan;157(1):116-20. doi: 10.1016/0002-9610(89)90430-3.
Forty-one patients with caustic ingestion were reviewed. Eighty-three percent were children, all of whom suffered accidental injury. Liquid drain cleaner was the agent in 57 percent and was responsible for all esophageal burns. Symptoms and physical findings were unreliable in predicting the extent of injury. Endoscopy was performed in most patients within 36 hours of ingestion and accurately estimated the risk of subsequent esophageal stricture formation. Steroid administration had no influence on the development of strictures. Esophageal strictures developed in 22 percent of the patients. One-third were successfully managed by periodic dilation, whereas the remaining two-thirds required esophagectomy and reconstruction. Early endoscopic evaluation was the best means of assessing the degree of injury after caustic ingestion. Routine steroid administration had no apparent clinical benefit.
回顾了41例腐蚀性物质摄入患者。83%为儿童，均为意外伤害。57%的病例病因是液体下水道清洁剂，且所有食管烧伤均由其导致。症状和体格检查结果在预测损伤程度方面并不可靠。大多数患者在摄入后36小时内接受了内镜检查，该检查准确地评估了随后发生食管狭窄的风险。给予类固醇对狭窄的发生没有影响。22%的患者发生了食管狭窄。三分之一通过定期扩张成功治疗，而其余三分之二则需要进行食管切除术和重建。早期内镜评估是评估腐蚀性物质摄入后损伤程度的最佳方法。常规给予类固醇没有明显的临床益处。
