Moletta Lucia, Pierobon Elisa Sefora, Salvador Renato, Volpin Francesco, Finocchiaro Francesco Massimiliano, Capovilla Giovanni, Piangerelli Alfredo, Ciccioli Eleonora, Zanchettin Gianpietro, Costantini Mario, Merigliano Stefano, Valmasoni Michele
Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Clinica Chirurgica 3°, Via Giustiniani 2, Padova, Italy.
Department of Neurosciences, University Hospital of Padova, Unit of Neurosurgery, Via Giustiniani 2, Padova, Italy.
Global Spine J. 2022 May;12(4):719-731. doi: 10.1177/21925682211005737. Epub 2021 Apr 23.
Case series and systematic review of the Literature.
Pharyngo-esophageal perforation (PEP) is a rare, life-threatening complication of anterior cervical spine surgery (ACSS). Best management of these patients remains poorly defined. The aim of this study is to present our experience with this entity and to perform a systematic Literature review to better clarify the appropriate treatment of these patients.
Patients referred to our center for PEP following ACSS (January 2002-December 2018) were identified from our database. Moreover, an extensive review of the English Literature was conducted according to the 2009 PRISMA guidelines.
Twelve patients were referred to our Institution for PEP following ACSS. Indications for ACSS were trauma (n = 10), vertebral metastases (n = 1) and disc herniation (n = 1). All patients underwent hardware placement at the time of ACSS. There were 6 early and 6 delayed PEP. Surgical treatment was performed in 11 patients with total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement, anatomical suture of the fistula and suture line reinforcement with myoplasty. Complete resolution of PEP was observed in 6 patients. Five patients experienced PEP persistence, requiring further surgical management in 2 cases. At a median follow-up of 18.8 months, all patients exhibited permanent resolution of the perforation.
PEP following ACSS is a rare but dreadful complication. Partial or total removal of the fixation devices, direct suture of the esophageal defect and coverage with tissue flaps seems to be an effective surgical approach in these patients.
病例系列及文献系统综述。
咽食管穿孔（PEP）是颈椎前路手术（ACSS）罕见且危及生命的并发症。这些患者的最佳治疗方案仍不明确。本研究旨在介绍我们对该病症的经验，并进行文献系统综述以更好地明确这些患者的恰当治疗方法。
从我们的数据库中识别出2002年1月至2018年12月因ACSS后发生PEP而转诊至我们中心的患者。此外，根据2009年PRISMA指南对英文文献进行了广泛检索。
12例患者因ACSS后发生PEP转诊至我们机构。ACSS的适应证为创伤（n = 10）、椎体转移瘤（n = 1）和椎间盘突出（n = 1）。所有患者在ACSS时均进行了内固定置入。有6例早期PEP和6例延迟性PEP。11例患者接受了手术治疗，包括全部或部分移除脊柱固定装置、植入自体骨移植或进行钢板/椎间融合器置换、瘘管的解剖缝合以及用肌成形术加强缝合线。6例患者的PEP完全消退。5例患者的PEP持续存在，其中2例需要进一步手术治疗。中位随访18.8个月时，所有患者的穿孔均永久性消退。
ACSS后发生的PEP是一种罕见但可怕的并发症。部分或全部移除固定装置、直接缝合食管缺损并用组织瓣覆盖似乎是治疗这些患者的有效手术方法。
