Lee Thomas S, Appelbaum Eric N, Sheen Derek, Han Reintine, Wie Benjamin
Virginia Commonwealth University, Department of Otolaryngology-Head and Neck Surgery, USA.
Baylor College of Medicine, Department of Otolaryngology-Head and Neck Surgery, USA.
Int J Otolaryngol. 2019 Jun 25;2019:7682654. doi: 10.1155/2019/7682654. eCollection 2019.
This case series discusses surgical management of esophageal perforations that occurred following cervical spine hardware placement. (1) Determine presenting symptoms of esophageal perforation after anterior cervical spine hardware placement. (2) Discuss surgical management of these resulting esophageal perforation complications. Case series of six patients at a tertiary-care, academic medical center. Six patients with pharyngoesophageal perforations following anterior cervical spine surgery (ACSS) Date of ACSS, indication for ACSS, level of hardware, location of esophageal or pharyngeal injury, symptoms at presentation, surgical intervention, type of reconstruction flap, wound culture flora, and antibiotic choice. A retrospective review of patients with an esophageal or hypopharyngeal injury in the setting of prior ACSS managed by the otolaryngology service at a tertiary, academic center between January 2015 and January 2019. Six patients who experienced pharyngoesophageal perforation following ACSS are included in this study. Range of presentation was two weeks to eight years following initial hardware placement. Five patients presented with an abscess and all had evidence of perforation on initial CT or esophagram. All patients underwent repair with a sternocleidomastoid flap with two patients eventually requiring an additional pectoralis myofascial flap for a persistent esophageal leak. Five patients eventually attained ability to tolerate oral nutrition. An algorithm detailing surgical reconstructive management is proposed. Esophageal perforations in the setting of prior ACSS are challenging clinical problems faced by otolaryngologists. Consideration should be given to early drainage of abscesses and spine surgery evaluation. Spinal hardware removal is recommended whenever possible. Utilization of a pedicled muscle flap reinforces primary closure and allows coverage of the vertebral bony defect. Nutrition, thyroid repletion, and culture-directed IV antibiotics are necessary to optimize esophageal perforation repair.
本病例系列讨论了颈椎置入内固定装置后发生的食管穿孔的手术治疗。（1）确定颈椎前路置入内固定装置后食管穿孔的表现症状。（2）讨论这些由此产生的食管穿孔并发症的手术治疗。一家三级医疗学术医学中心的6例患者的病例系列。6例颈椎前路手术后发生咽食管穿孔的患者：颈椎前路手术日期、颈椎前路手术指征、内固定装置位置、食管或咽部损伤部位、就诊时症状、手术干预、重建皮瓣类型、伤口培养菌群及抗生素选择。对2015年1月至2019年1月期间在一家三级学术中心由耳鼻喉科诊治的既往颈椎前路手术患者中发生食管或下咽损伤的患者进行回顾性研究。本研究纳入了6例颈椎前路手术后发生咽食管穿孔的患者。发病时间为初次置入内固定装置后2周至8年。5例患者出现脓肿，所有患者在初次CT或食管造影检查时均有穿孔证据。所有患者均采用胸锁乳突肌皮瓣修复，2例患者最终因持续性食管漏需要额外的胸大肌肌筋膜皮瓣。5例患者最终能够耐受经口营养。提出了详细说明手术重建治疗的算法。既往颈椎前路手术患者发生的食管穿孔是耳鼻喉科医生面临的具有挑战性的临床问题。应考虑早期引流脓肿并进行脊柱手术评估。尽可能建议取出脊柱内固定装置。使用带蒂肌皮瓣可加强一期缝合并覆盖椎体骨缺损。营养支持、补充甲状腺素及根据培养结果使用静脉抗生素对于优化食管穿孔修复是必要的。
