Barmparas G, Navsaria P H, Serna-Gallegos D, Nicol A J, Edu S, Sayari A A, Margulies D R, Ley E J
1 Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
2 Department of Surgery, Trauma Centre, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Scand J Surg. 2018 Dec;107(4):336-344. doi: 10.1177/1457496918766692. Epub 2018 Apr 9.
: Blunt pharyngoesophageal injuries pose a management challenge to the trauma surgeon. The purpose of this study was to explore whether these injuries can be managed expectantly without neck exploration.
: The National Trauma Databank datasets 2007-2011 were reviewed for blunt trauma patients who sustained a pharyngeal injury, including an injury to the cervical esophagus. Patients who survived over 24 h and were not transferred from other institutions were divided into two groups based on whether a neck exploration was performed. Outcomes included mortality and hospital stay.
: A total of 545 (0.02%) patients were identified. The median age was 18 years and 69% were male. Facial fractures were found in 16%, while 13% had an associated traumatic brain injury. Of the 284 patients who survived over 24 h and were not transferred from another institution, 65 (23%) underwent a neck exploration. The injury burden was significantly higher in this group as indicated by the higher median Injury Severity Score (17 vs 10, p < 0.01) and need for intensive care unit admission (75% vs 31%, p < 0.01). The overall mortality was 2%: 3.1% for neck explorations versus 1.6% for conservative management (adjusted p = 0.54). Neck exploration patients were more likely to remain longer in the hospital (median 13 vs 10 days, adjusted p = 0.03).
: Pharyngoesophageal injuries are rare following blunt trauma. Only a quarter require a neck exploration and this decision appears to be dictated by the injury burden. Selective non-operative management based on clinical status seems to be feasible and is not associated with increased mortality.
钝性咽喉食管损伤给创伤外科医生带来了管理挑战。本研究的目的是探讨这些损伤是否可以在不进行颈部探查的情况下进行保守治疗。
回顾2007 - 2011年国家创伤数据库中遭受咽喉损伤（包括颈段食管损伤）的钝性创伤患者的数据。存活超过24小时且未从其他机构转入的患者根据是否进行颈部探查分为两组。观察指标包括死亡率和住院时间。
共识别出545例（0.02%）患者。中位年龄为18岁，69%为男性。16%的患者有面部骨折，13%的患者伴有创伤性脑损伤。在284例存活超过24小时且未从其他机构转入的患者中，65例（23%）接受了颈部探查。该组的损伤严重程度明显更高，表现为更高的中位损伤严重度评分（17对10，p < 0.01）以及入住重症监护病房的需求（75%对31%，p < 0.01）。总体死亡率为2%：颈部探查组为3.1%，保守治疗组为1.6%（校正p = 0.54）。接受颈部探查的患者住院时间更可能更长（中位时间13天对10天，校正p = 0.03）。
钝性创伤后咽喉食管损伤罕见。仅四分之一的患者需要进行颈部探查，这一决定似乎取决于损伤严重程度。基于临床状况的选择性非手术治疗似乎是可行的，且与死亡率增加无关。
